10- 144 C.M.R. ch. 505, § 1

Current through 2024-51, December 18, 2024

Section 144-505-1 - DEFINITIONS

A. The term "institutional health services" means health services which are provided in or through health care facilities (as defined in E. below) or health maintenance organizations (as defined in F. below) and entail annual operating costs of at least $75,000 for the 12 month period beginning October 1, 1979 or, in any 12 month period thereafter, the figure in effect for the preceding 12 month period in an index specified by the Secretary of the Department of Health and Human Services.

B. The term "existing institutional health services" or "services" means institutional health services:

1. being offered in the health service area at the time of review for appropriateness, or

2. offered at any time in the 12 months prior to the review and also planned to be offered at any time in the 12 months following the review, or

3. which will be offered during the 12 months following the review.

C. A finding of "appropriateness" means a finding that a service meets the needs of a population, in accordance with the general criteria set forth below and any specific criteria or standards published by either SHPDA or BSA prior to the commencement of its review of an existing health service.

D. The term "areawide review" means the review of a specific existing institutional health service as delivered by all the institutions providing the service in the State of Maine or in such other substate areas as may be deemed appropriate:

1. which shall culminate in recommendations regarding the appropriateness of that service over the entire health service area, or such other substate areas as deemed appropriate, and

2. which may result in recommendations regarding the appropriateness of that service in a particular institution.

E. The term "health care facility" means hospitals, skilled nursing facilities, kidney disease treatment centers (including freestanding hemodialysis units), intermediate care facilities, rehabilitation facilities, organized ambulatory care facilities and ambulatory surgical facilities, but does not include Christian science sanitariums operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts. Further:

1. The term "hospital" means an institution which primarily provides to inpatients, by or under the supervision of physicians, diagnostic services and therapeutic services for medical diagnosis, treatment and care of injured, disabled or sick persons. This term also includes psychiatric and tuberculosis hospitals.

2. The term "psychiatric hospital" means an institution which primarily provides to inpatients, by or under the supervision of A physician, psychiatric services for the diagnosis and treatment of mentally persons.

3. The term "tuberculosis hospital" means an institution which primarily provides to inpatients, by or under the supervision of a physician, medical services for the diagnosis and treatment of tuberculosis.

4. Skilled Nursing Facility. A facility or distinct part of a facility licensed or certified by the Department of Human Services as a skilled nursing facility to provide skilled nursing care -- a service necessitating skilled nursing techniques and/or medical therapy of a complex and/or intensive degree on a long-term basis. The care would meet the current health needs and promote the maximum physical and psychosocial well-being of patients receiving such care on a 24-hour basis. Licensed nursing care and supervision is required.

5. Intermediate Care Facility. A facility or distinct part of a facility licensed or certified by the Department of Human Services as an intermediate care facility to provide medically and socially oriented nursing care necessitating licensed Nursing supervision and/or services and/ or medical therapy of a moderately complex yet specific nature on a long-term basis. This care would meet the current health needs and promote the maximum physical and psycho-social well-being of patients receiving such care.

6. The term "rehabilitation facility" means an inpatient facility which is operated for the primary purpose of assisting in the rehabilitation of disabled persons through an integrated program of medical and other health services which are provided under competent professional supervision. The term "organized ambulatory care facility" means a facility which provides health care services to patients not requiring inpatient care and includes health centers, outpatient clinics, and facilities providing diagnostic and therapeutic radiology services, but does not include the offices of physicians, dentists and other health professionals, whether in individual or group practice.

7. The term "organized ambulatory care facility" means a facility which provides health care services to patients not requiring inpatient care and includes health centers, outpatient clinics, and facilities providing diagnostic and therapeutic radiology services, but does not include the offices of physicians, dentists, and other health professionals, whether in individual or group practice.

8. The term "ambulatory surgical facility" means a facility, not a part of a hospital, which provides surgical treatment to patients not requiring hospitalization. The term does not include the offices of private physicians or dentists, whether, for individual or group practice.

F. The term "health maintenance organization" or "HMO" means a public or private organization organized under the laws of any State, (1) which is a qualified health maintenance organization under section 1310(d) of the Public Health Service Act, or (2) which:

1. 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

2. is compensated (except for copayments) for the provision of the basic health care services listed in paragraph (2)i. 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 the frequency,, extent, or kind of health service actually provided; and

3. provides physicians' services primarily (1) directly through physicians who are either employees or partners of the organization, or (2) through arrangements with individual physicians or one or more groups of physicians (organized on a group practice or individual practice basis).

G. The term "health maintenance organization for which assistance may be provided under Title XIII" means a health maintenance organization which is qualified under Section 1310(d) of the Public Health Service Act or an HMO which the Secretary of the Department of Health and Human Services determines, upon the bases of an application and the submission of any information and assurances which he finds necessary, may be eligible for assistance under Title XIII of the Social Security Act.

H. The term "health" includes physical and mental health.

I. The term "health services" means clinically related (i.e., diagnostic, treatment, or rehabilitative), preventive and health education services, and includes:

1. alcohol, drug abuse, and mental health services which are provided by fixed or mobile computed tomographic (CT) scanning equipment. A CT head scanner and a CT body scanner are considered to provide separate services. A CT fixed scanner and a CT mobile scanner are considered to provide separate services.

J. The term "Person" means an individual, a trust or estate, a partnership, a corporation (including associations, joint stock companies, and insurance companies), a State, a political subdivision or an instrumentality (including a municipal corporation) of a State, or any other legal ..entity recognized by the State.

K. The term "Act" refers to the National Health Planning and Development Act of 1974 as amended.

10- 144 C.M.R. ch. 505, § 1