reglab/statecodes huggingface dataset:
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-5 - END STAGE RENAL DISEASE TREATMENT AND TRANSPLANT CENTERS › Section 420-5-5-.01 - General

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Legal
			 Authority.
(a) Adoption of Rules. Under and
			 by virtue of authority vested in it by the Legislature of Alabama,
Code of Ala. 1975
, Sections
			 22-21-20, et. seq., the State
			 Board of Health does hereby adopt and promulgate the following Rules governing
			 the operation of End Stage Renal Disease Treatment and Transplant Centers in
			 the State of Alabama.
(b) End Stage
			 Renal Disease Treatment and Transplant Centers. For the purpose of these Rules
			 "End Stage Renal Disease Treatment and Transplant Centers" shall include
			 facilities that are intended to treat persons suffering permanent and
			 irreversible kidney failure, who require dialysis on a regular maintenance
			 basis, or who may be of suitable candidates for kidney transplantation. The
			 facilities that are classified under these Rules as "End Stage Renal Disease
			 Treatment and Transplant Centers" are further defined in these Rules as Renal
			 Dialysis Centers, Renal Dialysis Facilities and Renal Transplantation
			 Centers.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-5 - END STAGE RENAL DISEASE TREATMENT AND TRANSPLANT CENTERS › Section 420-5-5-.02 - Administration

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Governing
			 Authority.
(a) Responsibility. The governing
			 authority or the owner or the person or persons designated by the owner as the
			 governing authority shall be the supreme authority of the facility, responsible
			 for the management, control, and operation of the facility, including the
			 appointment of a qualified medical staff (or in the absence of an organized
			 medical staff) a medical director.
(b) Organization. The governing authority
			 shall be formally organized in accordance with a written constitution and/or
			 bylaws. In the event the governing authority consists of one person, this
			 requirement must still be met. Such constitution and/or bylaws shall include:
1. Identification of the facility.
2. The purpose for which the facility is
			 organized.
3. Length of tenure and
			 mechanism for appointment of members of the governing body.
4. Appointments and duties of the chief
			 executive officer.
5. Requirement
			 that the medical staff (if such exists) be organized in accordance with bylaws
			 approved by the governing authority.
6. Mechanism for appointment of medical staff
			 members and a medical director.
7.
			 Mechanism for approval of medical staff bylaws and policies governing
			 activities of the medical director if an organized medical staff does not
			 exist.
(c) Meetings. The
			 governing authority shall meet regularly. A copy of the minutes of these
			 meetings shall be kept as a permanent record of the facility.
(d) Notification of Chief Executive Officer.
			 The State Board of Health shall be advised of the chief executive officer's
			 name within 15 days of his appointment.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-5 - END STAGE RENAL DISEASE TREATMENT AND TRANSPLANT CENTERS › Section 420-5-5-.04 - Physical Environment

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Submission of Plans and Specifications.
(a)
			 Scope. A facility constructed or renovated after the effective date of these
			 rules shall be classified as Ambulatory Health Care Occupancy of the Life
			 Safety Code, and Business Occupancy of the Standard Building Code, and shall
			 comply with the codes and standards adopted by the State Board of Health at the
			 time of plan submission.
(b) New
			 Construction, Additions, and Major Alterations. When construction is
			 contemplated, either for new buildings, conversions, additions, or major
			 alterations to existing buildings coming within the scope of these Rules, plans
			 and specifications shall be submitted for review and approval to the Alabama
			 Department of Public Health, in accordance with Alabama Administrative Code
			 Rule 420-5-22, "Submission of Plans and Specifications for Health Care
			 Facilities."
(c) Minor Alterations
			 and Remodeling. Minor alterations and remodeling which do not affect the
			 structural integrity of the building, which do not change functional operation,
			 which do not affect fire safety, and which do not add beds or facilities over
			 those for which the dialysis and/or transplant facility is licensed, need not
			 be submitted for approval.
(d)
			 Inspections. The Alabama Department of Public Health and its authorized
			 representatives shall have access to the work for inspection wherever it is in
			 preparation or progress.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.03 - Review By The Department

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Within the statutory time frames, the
			 Department will determine whether the information submitted in the application
			 for a Certificate of Authority is complete. If the information is not complete,
			 the Department will send notification in writing to the applicant stating that
			 additional information is needed. In this event, the Department may require the
			 organization to provide proof that all Department of Insurance requirements
			 have been satisfied before accepting further Certificate of Authority
			 submissions. Failure to meet all Alabama Department of Public Health
			 requirements for a properly completed application in a ten-month period may
			 result in the organization being required to begin the application process
			 again.
(2) Before the Department
			 certifies to the Insurance Commissioner that the proposed health maintenance
			 organization meets the requirements of
			 420-5-6-.02, it will conduct a
			 thorough assessment to ascertain whether the proposed health maintenance
			 organization, the plan under which it proposes to operate, and the services
			 which it proposes to provide are consistent with the purposes and provisions of
Code of Ala. 1975
, §§
								27-21A-1,
et
seq
., and this
			 Chapter.
(3) Within 90 days of
			 receipt of a properly completed application for a Certificate of Authority, the
			 State Health Officer will do either of the following:
(a) Certify to the Insurance Commissioner
			 that the proposed health maintenance organization meets all requirements of the
			 State Board of Health; or
(b)
			 Disapprove the application, specifying in writing to the proposed health
			 maintenance organization and Insurance Commissioner the reasons for such
			 disapproval.
Author:
Department of Public
				Health
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.05 - Organization

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The health
			 maintenance organization shall be organized in a manner which allows the
			 accomplishment of its stated mission which shall include, as a minimum,
			 delivery of basic health care services, as well as covered frequently utilized
			 specialty services and ancillary services.
(2) The plan shall possess organizational and
			 administrative capacity to provide services and the ability to monitor
			 provision of such services.
(3) The
			 plan shall demonstrate separation of medical services from fiscal management
			 sufficient to assure that medical decisions will not be inappropriately
			 influenced by fiscal management.
(4) The governing body of the health
			 maintenance organization shall be responsible for establishment and oversight
			 of the health maintenance organization's health delivery system. The
			 responsibilities of the governing body of the health maintenance organization
			 shall include, but not be limited to, the following:
(a) Adoption and enforcement of all policies
			 governing the health maintenance organization's management of health care
			 services delivery, quality improvement and utilization review programs
			 including annual meetings for the purpose of evaluation and improvement of the
			 health services of the health maintenance organization and to react to
			 recommendations and findings of the quality improvement committee;
1. The governing body shall keep minutes of
			 meetings and other records to document the fact that the governing body is
			 effectively discharging the obligations of its office regarding health
			 services.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.06 - Assurance Of Access To And Continuity Of Care

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A health maintenance organization shall
			 have available sufficient personnel to meet the standards set forth in this
			 Chapter and its contractual obligations.
(2) When health care services are not
			 provided directly, a health maintenance organization shall develop and maintain
			 written executed contracts for the provision of the health services contracted
			 for by its enrollees.
(3) The
			 Department may grant a waiver from the requirement for executed provider
			 contracts in certain areas of health care, if the Department determines that:
(a) The specific services are services which,
			 because of an emergency, it was medically necessary to provide to the enrollee
			 other than through contracted providers; or
(b) The specific service or services being
			 reviewed are unusual or infrequently used health services.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.07 - Quality Improvement And Utilization Review

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A health maintenance organization shall
			 develop and implement a quality improvement program subject to the approval of
			 the State Health Officer that includes organizational arrangements and ongoing
			 procedures for the identification, evaluation, resolution, and follow-up of
			 potential and actual problems in health care administration and delivery to
			 enrollees.
(2) The quality
			 improvement organizational arrangements and ongoing procedures must be fully
			 described in written form, provided to all members of the governing body,
			 providers, and staff, and made available, upon request, to enrollees of the
			 health maintenance organization.
(3) The organizational arrangements for the
			 quality improvement program must be clearly defined and transmitted to all
			 individuals involved in the quality improvement program and should include, but
			 not be limited to, the following:
(a) A
			 quality improvement committee responsible for quality improvement activities
			 and utilization review activities;
(b) Accountability of the committee to the
			 administrator and the governing body of the health maintenance organization
			 including annual written and oral reports to the governing body. The written
			 reports shall contain;
1. Studies undertaken,
			 results, subsequent actions, and aggregate data on utilization and quality of
			 services rendered to enrollees.
(c) Participation from an appropriate base of
			 providers and support staff;
(d)
			 Supervision by medical director;
(e) A minimum of quarterly meetings at
			 appropriate location;
(f) Minutes
			 or records of the meeting of the quality improvement committee describing the
			 actions of the committee including problems discussed, recommendations made,
			 and any other pertinent discussions and activities; and
(g) Information concerning quality
			 improvement shall be treated as confidential information in accordance with
Code of Ala. 1975
, §
									27-21A-24 and 25.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.08 - Complaint System

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A health
			 maintenance organization shall have an enrollee complaint process, to include
			 an informal review, a formal review, and an expedited formal review for the
			 prompt resolution of complaints regarding such things as (a) the availability,
			 delivery, or quality of health care service, (b) claims payment, handling or
			 reimbursement for health care services, (c) matters pertaining to the
			 administrative or contractual relationship, or both, between an enrollee and
			 the health maintenance organization. Issues which can be resolved by telephone
			 to the enrollee's satisfaction shall not be classified as a complaint.
(a) Inquiry means normal business operations
			 conducted verbally or in writing between the health maintenance organization
			 and enrollees. These inquiries may include such things as requests for
			 identification cards, clarification of benefits, and address changes. Inquiries
			 will be resolved to the enrollee's satisfaction and within a time frame that is
			 acceptable to the enrollee. Inquiries shall be tracked and trended by issue
			 involved to allow the health maintenance organization to identify systemic or
			 commonly occurring areas.
(b)
			 Informal Complaint means those issues that are not resolved to the members
			 satisfaction at the inquiry level or for which the enrollee requests a written
			 response. Informal complaints will be tracked in accordance with Chapter
			 420-5-6-.08(4).
(c) Formal complaint means the subsequent
			 written expression by or on behalf of an enrollee regarding the resolution of
			 an informal complaint. Discussions between a provider and the health
			 maintenance organization during the utilization review process do not
			 constitute a formal complaint. Authorization from the enrollee shall not be
			 required for the provider's involvement in the utilization review process.
A provider may act on behalf of the enrollee in the formal
				complaint process if the physician certifies in writing that the enrollee is
				unable to act on his or her own behalf due to illness or disability. A family
				member, friend of the enrollee, or any other person may act on behalf of the
				enrollee after written notification to the health maintenance organization by
				the enrollee. A provider may also access the provider dispute mechanism as set
				forth in the provider contract without written authorization of the
				enrollee.
(d) Expedited
			 Formal Complaint means a verbal or written request by the enrollee or the
			 provider regarding an adverse medical necessity decision in the utilization
			 review process. The request must describe the medical urgency of the situation
			 to justify the expedited process.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.09 - Enrollee Documents

Current through Register Vol. 42, No. 9, June 28, 2024
(1) An
			 enrollee contract is the document which is to be issued to employers, unions,
			 trustees, or other organizations and individuals. Every health maintenance
			 organization shall offer at least one contract to all enrollees which shall
			 include:
(a) Definitions;
(b) Eligibility for enrollment; At a minimum:
1. Enrollees must work or live in the health
			 maintenance organization service area to be eligible for group
			 coverage.
2. Enrollees must live in
			 the health maintenance organization service area to be eligible for individual
			 coverage.
(c) Health
			 care services to be provided;
(d)
			 Where and in what manner the health care services may be obtained including
			 explanation of primary care physician role;
(e) Provisions for adding new family
			 members;
(f) Benefits for newborn
			 children;
(g) Provisions relating
			 to termination or cancellation;
(h)
			 Limitations, exceptions, or exclusions;
(i) Provisions relating to preexisting
			 conditions, if applicable;
(j)
			 Provisions relating to coordination of benefits;
(k) Provisions relating to
			 subrogation;
(l) Any applicable
			 arbitration provisions;
(m)
			 Conversion privileges, if applicable;
(n) Complaint procedures;
(o) Any applicable copayments;
(p) Emergency services and out-of-area
			 coverage;
(q) Referral
			 services;
(r) The names of
			 contracted specialty physicians, the names and addresses of all contracted
			 OB/GYN providers, the names and addresses of contracted primary care providers,
			 hospitals, and ancillary providers are to be furnished as a supplement to
			 contracts; and
(s) Any other
			 factors necessary for complete understanding of what is covered and what is
			 excluded and such information required by the Alabama Department of Insurance.
Author:
Department of Public
				Health
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.11 - Professional Staffing of Health Maintenance Organizations

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Professional staff standards.
(a) A health maintenance organization shall
			 have a sufficient number of physicians to adequately cover the health care
			 needs of enrollees.
1. The health maintenance
			 organization shall conduct an annual affirmative capacity analysis of
			 availability of providers required to render covered services.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.12 - Enrollee Rights

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A health
			 maintenance organization shall develop and adhere to written procedures for
			 informing enrollees of at least the following rights:
(a) An enrollee has the right to timely and
			 effective redress of grievances through a system established under
			 420-5-6-.08;
(b) An enrollee has the right to obtain
			 current information concerning a diagnosis, treatment, and prognosis from a
			 physician or other provider in terms the enrollee can be reasonably expected to
			 understand. When it is not advisable to give such information to the enrollee,
			 the information shall be made available to an appropriate person on the
			 enrollee's behalf;
(c) An enrollee
			 has the right to be given the name, professional status, and function of any
			 personnel providing health services to him;
(d) An enrollee has the right to give his
			 informed consent before the start of any surgical procedure or
			 treatment;
(e) An enrollee has the
			 right to refuse any drugs, treatment, or other procedure offered to him by the
			 health maintenance organization or its providers to the extent provided by law
			 and to be informed by a physician of the medical consequences of the
			 subscriber's refusal of any drugs, treatment, or procedure;
(f) When emergency services are necessary, an
			 enrollee has the right to obtain such services without unnecessary
			 delay;
(g) An enrollee has the
			 right to have all records pertaining to his medical care treated as
			 confidential unless disclosure is otherwise permitted by law;
(h) An enrollee has the right to all
			 information in his medical records unless access is specifically restricted by
			 the attending physician for medical reasons;
(i) An enrollee has the right to be advised
			 if a health care facility or any of the providers participating in his care
			 propose to engage in or perform human experimentation or research affecting his
			 care or treatment. An enrollee or legally responsible party on his behalf may,
			 at any time, refuse to participate in or continue in any experimental or
			 research program to which he has previously given informed consent;
			 and
(j) An enrollee has the right
			 to be informed of these rights listed in this subsection.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.13 - External Quality Improvement Assessment

Current through Register Vol. 42, No. 9, June 28, 2024
(1) When the Department may direct for cause,
			 each health maintenance organization shall have an external quality improvement
			 assessment performed.
(2) The
			 assessment shall study the quality of care being provided to plan enrollees and
			 the effectiveness of the quality improvement program established according to
			 420-5-6-.07.
(3) The assessment shall be conducted by an
			 expert experienced in health maintenance organization review activities.
(a) The expert shall be hired by the health
			 maintenance organization and not involved in the operation or direction of the
			 health maintenance organization or in the delivery of health care services to
			 its enrollees.
(b) The expert must
			 be an individual or organization with recognized experience in the appraisal of
			 medical practice and quality improvement in a health maintenance organization
			 setting.
(c) The expert shall be
			 approved by the Department.
(d) The
			 expert shall review, at least, a statistically significant sample of medical
			 records.
(e) The expert shall issue
			 a written report of his findings to the health maintenance organization's
			 governing body.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.14 - Annual And Quarterly Reports

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Any person which has received a
			 Certificate of Authority to operate a health maintenance organization shall
			 submit before March 1 of each year a detailed report of its activities during
			 the preceding calendar year. The report shall include, at least, the following:
(a) A copy of the annual financial report
			 submitted to the Commissioner;
(b)
			 Copies of the quality improvement and utilization review reports submitted to
			 the governing body according to
			 420-5-6-.07;
(c) A copy of the complaint resolution system
			 established according to
			 420-5-6-.08, including a summary
			 of total number of complaints handled, a compilation of causes underlying the
			 complaints, and the resolution of complaints;
(d) A statement of number of providers
			 leaving the health maintenance organization and the number of providers
			 replacing them and total number of providers; and
(e) A summary of enrollment and disenrollment
			 rates during the year.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-6 - HEALTH MAINTENANCE ORGANIZATIONS › Section 420-5-6-.15 - Exceptions

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Department
			 may, at its discretion, for justifiable reasons and only in cases where the
			 health, safety, and welfare of any citizens would not be impaired, grant
			 exceptions to and departures from this Chapter when the policy objectives and
			 intentions of this Chapter are otherwise substantially met.
(2) A request for exceptions to this Chapter
			 shall be made in writing to the Department. A request, whether approved or not,
			 will be retained on file by the Department. An approved request shall be
			 retained on file by the health maintenance organization during the period the
			 exception remains in effect.
(3) An
			 exception granted under this Chapter may be revoked by the Department at its
			 discretion for good cause whenever the policy objectives and intentions for
			 granting the exception will no longer be furthered.
(4) The Department will give written notice
			 revoking an exception and will state the reason for its action and a specific
			 date upon which the exception will be terminated.
(a) The Department will provide a reasonable
			 time between the date of written notice of revocation and the date of
			 termination of an exception from compliance with the applicable
			 regulations.
(b) Failure of the
			 health maintenance organization to comply by the specified date may result in
			 action to revoke the previously approved Certificate of Authority.
(c) The Department's denial or revocation of
			 an exception is a final agency action and shall be appealable in accordance
			 with
Code of Ala. 1975
, §§
									27-21A-1,
et
seq
.
Author:
Department of Public
				Health
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.02 - The License

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Classifications of Licenses. All licenses are granted for the calendar year and
			 shall expire on December 31 unless renewed by the owner for the succeeding
			 year.
(a) Unrestricted License. An
			 unrestricted license may be granted by the Board after it has determined that
			 the hospital is willing and capable of maintaining compliance with these
			 rules.
(b) Probational License. At
			 its discretion, the Board may grant a probational license when it determines
			 that both of the following conditions exist:
1. The hospital has engaged in one or more
			 deficient practices which are serious in nature, chronic in nature, or which
			 the hospital has failed to correct.
2. The hospital's current governing authority
			 has demonstrated the capability and willingness to correct cited problems and
			 to maintain compliance.
(c) A probational license shall be granted
			 for a specific period which may be extended but which shall in no case exceed
			 one year.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.03 - Classification Of Hospitals

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 General.
(a) Classification According to
			 Services. Each hospital shall be classified as a General Acute Care Hospital, a
			 Critical Access Hospital or a Specialized Hospital, corresponding to the
			 services offered by the particular institution.
(b) Confinement of Services. A hospital shall
			 confine its services to those designated in the classification, except
			 emergency cases when the life or welfare of the patient is imperiled. In such
			 case the attending physician shall state on the patient record that emergency
			 conditions existed.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.04 - The Governing Authority

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A hospital shall have an effective
			 governing authority that is legally responsible for the conduct of the hospital
			 as an institution.
(2) Medical
			 staff. The governing authority shall:
(a)
			 Appoint members of the medical staff after considering the recommendations of
			 the existing members of the medical staff;
(b) Assure that the medical staff has
			 bylaws;
(c) Approve medical staff
			 bylaws and other medical staff rules and regulations;
(d) Ensure that the medical staff is
			 accountable to the governing body for the quality of care provided to
			 patients;
(e) Ensure the criteria
			 for selection are individual character, competence, training, experience, and
			 judgment; and
(f) Ensure that under
			 no circumstances the accordance of staff membership or professional privileges
			 in the hospital is dependent solely upon certification, fellowship, or
			 membership in a specialty body or society.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.05 - Patient Rights

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A hospital
			 shall protect and promote each patient's rights.
(2) Notice of rights.
(a) The hospital shall inform each patient,
			 or when appropriate, the patient's representative, of the patient's rights, in
			 advance of furnishing or discontinuing patient care whenever
			 possible.
(b) The hospital shall
			 establish a process for prompt resolution of patient grievances and shall
			 inform each patient whom to contact to file a grievance. The hospital's
			 governing authority shall approve and be responsible for the effective
			 operation of the grievance process and shall review and resolve grievances,
			 unless it delegates the responsibility in writing to a grievance committee. The
			 grievance process shall include a mechanism for timely referral of patient
			 concerns regarding quality of care or premature discharge to the appropriate
			 Utilization and Quality Control Quality Improvement Organization. At a minimum:
1. The hospital shall establish a clearly
			 explained procedure for the submission of a patient's written or verbal
			 grievance to the hospital.
2. The
			 grievance process shall specify time frames for review of the grievance and the
			 provision of a response.
3. In its
			 resolution of the grievance, the hospital shall provide the patient with
			 written notice of its decision that contains the name of the hospital contact
			 person, the steps taken on behalf of the patient to investigate the grievance,
			 the results of the grievance process, and the date of completion.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.06 - Personnel

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Personnel
			 Records. Each hospital shall maintain a personnel record for each employee. As
			 a minimum, the record shall include an application for employment that contains
			 information regarding the applicant's education, training experience, and if
			 applicable, registration or licensure information.
(2) Each hospital shall establish vaccination
			 requirements for employees that are consistent with current recommendations of
			 the Federal Centers for Disease Control and Prevention (CDC) and the Federal
			 Occupational Safety and Health Administration (OSHA).
(3) Personnel absent from duty because of any
			 communicable disease shall not return to duty until hospital policy on
			 communicable diseases is followed. Said hospital policy shall be consistent
			 with current standards of practice and recommendations of CDC. Documentation of
			 the absence of communicable diseases shall be maintained in facility
			 records.
Rule .04 was renumbered to .06 as per certification filed
				  August 24, 2012; effective September 28,
				  2012.
Author:
W.T. Geary, Jr., M.D., Carter
				  Sims
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-21-20, et seq.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.07 - Physical Environment

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A
			 hospital shall be constructed, arranged, and maintained to ensure the safety of
			 the patient, and to provide facilities for diagnosis and treatment and for
			 special hospital services appropriate to the needs of the community.
(2) Buildings and grounds shall be developed
			 and maintained in such a manner that the safety and well-being of building
			 occupants are assured.
(a) Emergency power
			 and lighting are required in at least the operating, recovery, intensive care,
			 and emergency rooms, and stairwells. In all other areas not serviced by the
			 emergency power source, battery lamps and flashlights shall be
			 available.
(b) Emergency gas and
			 water supplies are required.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.08 - Patient Transport

Current through Register Vol. 42, No. 9, June 28, 2024
For transportation out of a facility, if a patient is unable to
				ride in an upright position or if such patient's condition is such that he or
				she needs observation or treatment by emergency medical services personnel, or
				if the patient requires transportation on a stretcher, gurney or cot, the
				facility shall arrange or request transportation services only from providers
				who are ambulance service operators licensed by the Board. If such patient is
				being transported to or from a health care facility in another state,
				transportation services may be arranged with a transport provider licensed as
				an ambulance service operator in that state. For the purposes of this rule, an
				upright position means no more than 20 degrees from vertical.
Rule .29 was renumbered to .08 as per certification filed
				  August 24, 2012; effective September 28,
				  2012.
Author:
W.T. Geary, Jr., M.D., Carter
				  Sims
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-21-20, et seq.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.09 - Medical Staff

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 hospital shall have an organized medical staff that operates under bylaws
			 approved by the governing authority and is responsible for the quality of
			 medical care provided to patients by the hospital.
(2) Composition of the medical staff. The
			 medical staff shall be composed of doctors of medicine or osteopathy and may
			 also be composed of other practitioners appointed by the governing authority.
(a) The medical staff shall periodically
			 conduct appraisals of its members.
(b) The medical staff shall examine
			 credentials of candidates for medical staff membership and make recommendations
			 to the governing authority on the appointment of the candidates.
(c) Hospitals may provide telemedicine
			 services to their patients if these medical services are provided pursuant to a
			 written contract. If these services are provided by contract with another
			 hospital that hospital shall be a Medicare-participating hospital and assure
			 the physicians providing the telemedicine services are privileged to offer the
			 services in the second hospital and are licensed in Alabama. If these services
			 are provided by a distant-site telemedicine entity other than a
			 Medicare-participating hospital, the physicians must be appropriately
			 credentialed to provide these services and must be licensed in
			 Alabama.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.10 - Quality Assurance Or Quality Assessment And Performance Improvement (QAPI) Program

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 hospital shall develop, implement, and maintain an effective, ongoing,
			 hospital-wide, data-driven quality assurance or quality assessment and
			 performance improvement (QAPI) program. The hospital's governing authority
			 shall ensure that the program reflects the complexity of the hospital's
			 organization and services; involves all hospital departments and services
			 (including those services furnished under contract or arrangement); and focuses
			 on indicators related to improved health outcomes and the prevention and
			 reduction of medical errors. The hospital shall maintain and demonstrate
			 evidence of its QAPI program for review by the Department.
(2) Program scope.
(a) The program shall include an ongoing
			 program that shows measurable improvement in indicators for which there is
			 evidence that it will improve health outcomes and identify and reduce medical
			 errors.
(b) The hospital shall
			 measure, analyze, and track quality indicators, including adverse patient
			 events, and other aspects of performance that assess processes of care,
			 hospital service and operations.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.11 - Nursing Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 hospital shall have an organized nursing service that provides 24-hour nursing
			 services. The nursing services shall be furnished or supervised by a registered
			 nurse.
(2) Organization. The
			 hospital shall have a well-organized service with a plan of administrative
			 authority and delineation of responsibilities for patient care. The director of
			 the nursing service shall be a licensed registered nurse with an active,
			 unencumbered registered nurse license issued by the Alabama Board of Nursing.
			 He or she is responsible for the operation of the service, including
			 determining the types and numbers of nursing personnel and staff necessary to
			 provide nursing care for all areas of the hospital.
(3) Staffing and delivery of care. The
			 nursing service shall have adequate numbers of licensed registered nurses,
			 licensed practical nurses, and other personnel to provide nursing care to all
			 patients as needed. There shall be supervisory and staff personnel for each
			 department or nursing unit to ensure, when needed, the immediate availability
			 of a registered nurse for bedside care of any patient. Where there is a
			 question about a physician's order the physician may be contacted by nursing
			 staff.
(a) The hospital shall provide 24-hour
			 nursing services furnished or supervised by a registered nurse, and have a
			 licensed practical nurse or registered nurse on duty at all times.
(b) The nursing service shall have a
			 procedure to ensure that hospital nursing personnel for whom licensure is
			 required have valid and current licensure.
(c) A registered nurse shall supervise and
			 evaluate the nursing care for each patient.
(d) The hospital shall ensure that the
			 nursing staff develops, and keeps current, a nursing care plan for each
			 patient.
(e) A registered nurse
			 shall assign the nursing care of each patient to other nursing personnel in
			 accordance with the patient's needs and the specialized qualifications and
			 competence of the nursing staff available.
(f) Non-employee licensed nurses who are
			 working in the hospital shall adhere to the policies and procedures of the
			 hospital. The director of nursing service shall provide for the adequate
			 supervision, licensure verification, and evaluation of the clinical activities
			 of non-employee nursing personnel which occur within the responsibility of the
			 nursing service.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.12 - Infection Control

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 hospital shall provide a sanitary environment to avoid sources and transmission
			 of infections and communicable diseases. There shall be an active program for
			 the prevention, control, and investigation of infections and communicable
			 diseases.
(2) Organization and
			 policies. A person or persons shall be designated as infection control officer
			 or officers to develop and implement policies governing control of infections
			 and communicable diseases. The infection control officer or officers shall
			 develop a system for identifying, reporting, investigating, and controlling
			 infections and communicable diseases of patients and personnel.
(3) Responsibilities of chief executive
			 officer, medical staff, and director of nursing services. The chief executive
			 officer, the medical staff, and the director of nursing services shall:
(a) Ensure that the hospital-wide quality
			 assurance program and training programs address problems identified by the
			 infection control officer or officers; and
(b) Be responsible for the implementation of
			 successful corrective action plans in affected problem areas.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.13 - Medical Record Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 The hospital shall have a medical record service that has administrative
			 responsibility for medical records. A medical record shall be maintained for
			 every individual evaluated or treated in the hospital.
(2) Organization and staffing. The
			 organization of the medical record service shall be appropriate to the scope
			 and complexity of the services performed. The hospital shall employ adequate
			 personnel to ensure prompt completion, filing, and retrieval of
			 records.
(3) Form and retention of
			 record. The hospital shall maintain a medical record for each inpatient and
			 outpatient. Medical records shall be accurately written, promptly completed,
			 properly filed and retained, and accessible. The hospital shall use a system of
			 author identification and record maintenance that ensures the integrity of the
			 authentication and protects the security of all record entries.
(a) Medical records shall be retained in
			 their original or legally reproduced form for a period of at least five years.
			 In the case of minor patients, records shall be retained for at least five
			 years after the patient has reached the age of majority.
(b) The hospital shall have a system of
			 coding and indexing medical records. The system shall allow for timely
			 retrieval by diagnosis and procedure, in order to support medical care
			 evaluation studies.
(c) The
			 hospital shall have a procedure for ensuring the confidentiality of patient
			 records. Information from or copies of records may be released only to
			 authorized individuals, and the hospital shall ensure that unauthorized
			 individuals cannot gain access to or alter patient records. Original medical
			 records shall be released by the hospital only in accordance with federal or
			 state laws, court orders, or subpoenas.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.14 - Food Dietetic Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The hospital shall have organized dietary
			 services that are directed and staffed by adequate qualified personnel.
			 However, a hospital that has a contract with an outside food management company
			 may meet the requirements of this rule if the company has a dietitian who
			 serves the hospital on a full-time, part-time, or consultant basis, and if the
			 company maintains at least the minimum standards specified in this rule and
			 provides for constant liaison with the hospital medical staff for
			 recommendations on dietetic policies affecting patient treatment.
(2) Organization.
(a) The hospital shall have a full-time
			 employee who:
1. Serves as director of the
			 food and dietetic service;
2. Is
			 responsible for the daily management of the dietary services; and
3. Is qualified by experience or
			 training.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.15 - Emergency Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 hospital shall meet the emergency needs of patients in accordance with
			 acceptable standards of practice.
(2) Organization and direction.
(a) The services shall be organized under the
			 direction of a qualified member of the medical staff.
(b) The services shall be integrated with
			 other departments of the hospital.
(c) The policies and procedures governing
			 medical care provided in the emergency service or department shall be
			 established by, and are a continuing responsibility of, the medical
			 staff.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.16 - Pharmaceutical Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 hospital shall have pharmaceutical services that meet the needs of the
			 patients. The institution shall have a pharmacy directed by a registered
			 pharmacist or a drug storage area under competent supervision. The medical
			 staff in conjunction with pharmacy department is responsible for developing and
			 approving policies and procedures that minimize drug errors. This function may
			 be delegated to the hospital's organized pharmaceutical service.
(2) Pharmacy management and administration.
			 The pharmacy or drug storage area shall be administered in accordance with
			 accepted professional principles.
(a) A
			 full-time, part-time, or consulting pharmacist shall be responsible for
			 developing, supervising, and coordinating all the activities of the pharmacy
			 services.
(b) The pharmaceutical
			 service shall have an adequate number of personnel to ensure quality
			 pharmaceutical services, including emergency services.
(c) Current and accurate records shall be
			 kept of the receipt and disposition of all scheduled drugs.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.17 - Surgical Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) If
			 the hospital provides surgical services, the services shall be well organized
			 and provided in accordance with acceptable standards of practice. If outpatient
			 surgical services are offered the services shall be consistent in quality with
			 inpatient care in accordance with the complexity of services offered.
(2) Organization and staffing. The
			 organization of the surgical services shall be appropriate to the scope of the
			 services offered.
(a) The operating rooms
			 shall be supervised by an experienced registered nurse or a doctor of medicine
			 or osteopathy.
(b) Licensed
			 practical nurses (LPNs) and surgical technologists (operating room technicians)
			 may serve as "scrub nurses" or "scrub techs" under the supervision of a
			 registered nurse.
(c) Qualified
			 registered nurses may perform circulating duties in the operating room. In
			 accordance with state laws and approved medical staff policies and procedures,
			 LPNs may assist in circulatory duties under the supervision of a qualified
			 registered nurse who is immediately available to respond to emergencies.
			 Registered nurses may also serve as registered nurse first assistants
			 (RNFAs).
(d) Surgical privileges
			 shall be delineated for all practitioners performing surgery in accordance with
			 the competencies of each practitioner. The surgical service shall maintain a
			 roster of practitioners specifying the surgical privileges of each
			 practitioner.
Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-5-7 - HOSPITALS › Section 420-5-7-.18 - Anesthesia Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) If
			 the hospital furnishes anesthesia services, they shall be provided in a
			 well-organized manner under the direction of a qualified doctor of medicine or
			 osteopathy. The service is responsible for all anesthesia administered in the
			 hospital.
(2) Organization and
			 staffing. The organization of anesthesia services shall be appropriate to the
			 scope of the services offered. Anesthesia must be administered only by:
(a) An anesthesiologist;
(b) A doctor of medicine or osteopathy (other
			 than an anesthesiologist);
(c) A
			 dentist or oral surgeon;
(d) A
			 podiatrist, but limited to administering local anesthetics to the
			 foot;
(e) A certified registered
			 nurse anesthetist (CRNA) who is performing or assisting in any act involving
			 the determination, preparation, administration, or monitoring of any drug used
			 to render an individual insensible to pain for surgical or other therapeutic or
			 diagnostic procedures and who is under the direction of a physician licensed to
			 practice medicine, or a dentist, who is immediately available; or
(f) An anesthesiologist's assistant who is
			 under the direction of an anesthesiologist who is immediately
			 available.