Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 5 - Health Planning
Chapter 123 - Glossary
Section I-12301 - Definitions of Words and Phrases Applicable to Health Planning
Accessibility-determination of the method and ease of an individual's (or group's) ability to obtain medical care. Geographic, financial, social, ethnic and psychic considerations affect the problem of accessibility. It is also a function of availability.
Accreditation-the recognition given an agency or organization that it meets certain predetermined standards following a process of formal evaluation. This differs from certification (see definition) which is a similar process applied to individuals. Accreditation is usually given by a private organization created for that purpose (such as the Joint commission on Accreditation of Hospitals). Accreditation provides evidence to the public that certain standards are met in terms of physical plant, governing body, administration, staff background and organization of services; it is not a condition of lawful practice, which is covered by licensure (see definition).
Administrative Staff-the staff responsible for the management of an organization or institution.
Admissions-The number of persons formally accepted for overnight care by a hospital or other inpatient health care facility.
Allied Health Personnel-specially trained and in some localities, licensed, health workers other than physicians, dentists, podiatrists and nurses. The term has no constant or agreed upon detailed meaning; sometimes being used synonymously with paramedical personnel; sometimes meaning all health workers who perform tasks which must otherwise be performed by a physician; and sometimes referring to health workers who do not usually engage in independent practice.
Ambulatory Care-all types of health services provided on an outpatient basis in contrast to inpatient hospital care. Inpatients may be ambulatory, but ambulatory care refers to patients receiving care in a facility without the requirement for an overnight stay.
Amortization-the systematic payment of debt over a specific period of time, generally on an installment basis.
Ancillary Services-hospital or other patient health services other than professional services. They may include x-ray, drug, and laboratory services.
Annual Report-the report of a facility showing assets and liabilities, receipts and disbursements, and other information for a specified 12-month period (fiscal or calendar year).
Applicant-any individual, group, firm, association, corporation, government unit, or other entity requiring a review of need.
Application-the forms and supplements required from applicants by the primary review agency or the designated planning agency.
Assets-all available properties and claims that may be used to pay liabilities.
Availability-a measure (in terms of type volume and location) of the supply of health resources and services relative to the needs/demand of a given individual or community. It is the function of the distribution of appropriate resources, services and personnel and the willingness of the provider to serve the particular patient and need. Availability differs from accessibility, to which it is closely related, by its emphasis on the supply side, while accessibility focuses on the ease by which an available facility can be used.
Average Daily Census-the mean of the daily population of a facility on an inpatient basis in a given time period (usually a year). It is derived by dividing the total number of patient days for the period by the number of calendar days in that period.
Average Length of Stay-the arithmetic mean of days of stay of in-patients over a given period of time. (Also see length of stay.)
Back Up Staff-supporting staff to professional personnel involved in routine patient and non-patient related work.
Bed-beds are often used as a measure of capacity. The total number in a facility is usually related to the minimum square foot standards developed by the USPHS and used by State Health Departments. Hospital size is often denoted by bed capacity. Beds in the emergency, anesthesia and recovery rooms as well as beds for special diagnostic purposes are excluded from the measure of capacity. Licenses and certificates of need may be granted for specific number of types of beds. Facilities may have both licensed and unlicensed beds as well as active and unused beds.
Billable Costs-operational costs of services to patients which can be billed to third party payors or patients themselves.
Birth Rate-a fraction, whose numerator is the total number of births in a population in a given period and whose denominator is the total number of person-years lived by the population during that period. The latter is generally approximated by the size of the population at the midpoint of the period multiplied by the length of the period in years. The rate is usually stated per 1,000 persons.
Board-the governing body of a health care institution. In a governmental hospital, the powers of a board are generally vested in elected officials, who may or may not carry out customary board functions.
Board Certified-descriptive of a physician or other health professional who has passed an examination given by a medical specialty board and been certified by that board as a specialist in the subject in question. The examination cannot be taken until the professional meets requirements set by the specialty board for board eligibility.
Bond Issues-the offering for sale to the public of bonds; a written promise under seal to pay a sum of money at some definite future time. Used in the raising of funds for long-term capital needs.
Capital Expenditure-an expenditure:
1. made by or on behalf of a health care facility;
2. which generally accepted accounting principles is not properly chargeable as an expense of operation and maintenance, or is made to obtain by lease or comparable arrangement any facility or part thereof or any equipment for a facility or part; and which exceeds the expenditure minimum, substantially changes the bed capacity of the facility with respect to which the expenditure is made, or substantially changes the services of such facility. For purposes of Paragraph 2, the cost of any studies, surveys, designs, plans, working drawings, specifications, and other activities essential to the acquisition, improvement, expansion, or replacement of any plant or any equipment with respect to which an expenditure described in Paragraph 2 is made shall be included in determining if such expenditure exceeds the expenditure minimum. Donations of equipment or facilities to a health care facility which if acquired directly by such facility would be subject to review under Section 422 shall be considered capital expenditures for purposes of Section 1122, and a transfer of equipment or facilities at fair market value would be subject to review under section 1122. For purposes of this paragraph, the term 'expenditure minimum' means $600,000.
Cash Flow-the revenues actually received and expenses actually paid by the facility. The difference represents the cash actually on hand or needed for repayment of expenses due.
Closure of Service-the elimination of a service in a health facility for reasons of cost effectiveness, duplication, or lack of need.
Community-used in several ways. May refer to a geographic entity whose boundaries depend on the frame of reference (the block, the neighborhood, the city, etc.); or to a group bound together by an association of interests (such as ethnic, religious or professional) of relevance to health facilities and planning bodies.
Community Participation-participation in a health facility or planning body by representatives or members of the defined community. (see definition) P. L. 93-641 and a number of other laws require community participation in the governing body. The guidelines for participation also define health service consumers and providers, and identify criteria for their inclusion.
Competing Proposal-proposals submitted to the reviewing agency by two or more facilities for providing similar services to the same population.
Competitive Bids-the practice of asking more than one contractor (generally three or more) to bid on a job that cannot be performed by the staff of a facility. The health facility provides the scope of work to be done and chooses between competing bids on the basis of price, time required, and judgment of the contractor's experience, staff and capability.
Consumer-the user of health care services or purchaser of health insurance; in terms of planning agencies, any person who does not provide health care services.
Consumer Charge-charge assessed against the patient (inpatient and outpatient) for services received. The charge may be less than, equal to, or more than the cost of services, depending on the patient's reimbursement method.
Continuity of Care-care provided so that all service elements affecting the health status of the patient, in a particular episode of care, and coordinated over a span of time. Coordination is achieved by the appropriate sharing of information between the levels of providers involved which may include a primary care physician, specialist(s), physician assistant(s), etc.
Cost Benefit Analysis-a method of analysis by which one can appraise the soundness of proposed activities by the calculation of the monetary values of the resources to be employed in the proposed activities (the cost) in comparison to the monetary value of the services to be produced (the benefit). If the anticipated returns compare favorable with the prospective ratios obtained from alternative uses to which resources might be put, the proposed activities may be regarded as sound.
Cost Containment-the attempt to slow down increases in cost or reduce the cost of health care by the introduction of more efficient methods of provider production, better organization of services, various economic incentives, or other mechanisms for regulating hospital costs. Cost containment has been among the objectives of public policy embodied in recent legislation including the Health Planning and Resources Development Act, PSRO, etc.
Cost Effectiveness-method of analysis in which costs are calculated and alternative methods are compared for achieving of results; the objective is both efficient use of funds and achievement of a specified result.
Criterion-a measureable characteristic of a health service (when used in the context of "Criteria and Standards").
Day Care Surgical Unit-within an institution, a unit related to a health care institution where minor surgery can be performed without the need of an overnight stay. It may be an integral part of a health facility or it may be free-standing.
Debt Retirement Fund-fund required by external sources to be used to meet debt service charges and the retirement of indebtedness on plant assets.
Demand-
1. in health economics it is the varying amount of a good or service sought at varying prices, given constant income and other factors;
2. in the operational sense, it is the sum of explicit requests, actual or projected, for a given medical care service. Demand may be generated by the patient when he initiates the medical care process, or by the doctor acting for the patient in the process of diagnosis and treatment. It differs from utilization, (the amount of services actually used) and need (the services required, though not necessarily requested, to maintain health status at some predetermined level).
Department-a functional or administrative division of a hospital, health program or government agency. In a hospital, it may be related to a medical specialty, i.e., pediatric, radiology, or surgery department.
Depreciation-the decline in value of capital assets with use over time. It assures an accounting life for the asset. The rate and amount of depreciation is calculated by a variety of methods whose purpose is the reviewing of historical cost, less salvage value, over the estimated lifetime of the asset.
Determination of Need-a determination, affirmative or negative in form, as to the need for one or more of the following: establishment of a new health facility at a designated location; replacement of an existing facility at its existing or at a new location; expansion, alteration, remodeling, renovation, or major repairs to an existing facility, or replacement of any part thereof, at its existing location; establishment by a hospital licensee of a new or relocated clinic at a different location from the hospital; any substantial change in the services of an existing facility at its existing or at a new location.
Diagnostic Services-services performed to aid in diagnosing or determining the nature of a disease. In the hospital setting, these services generally refer to the laboratory and x-ray procedures used as aids in diagnosis.
Difference Equations-a calculus approach to computing values (such as prevalence) at different periods.
Discharges-the number of patients released from a hospital (living or deceased) in a given period.
Economies of Scale-cost savings resulting from optimal use of resources in relation to production. For example, an increase in the number of physicians in a group up to a certain point may be accomplished without increasing administrative staff. Economies of scale occur as average cost decreases when one or any combination of factors of production are expanded proportionately.
Elective Admission-a scheduled hospital admission for which reasonable delays will not affect the outcome of the health problem unfavorably. The purpose of such admissions are to improve the patients' health, although they may not be lifesaving.
Emergency Care-care for patients with severe, life-threatening or potentially disabling conditions that require immediate intervention. Often provided in emergency wards which have been constructed for that purpose. Not all conditions seen in emergency wards, however, are of an emergent nature.
Emergency Medical Service System (EMSS)-an integrated system of appropriate health manpower, facilities, and equipment which provides all necessary emergency care in a defined geographic area. The development of such systems is federally assisted under the Emergency Medical Services Act of 1973, P.L. 93-54.
Evaluation-a systematic procedure for determining the degree of effectiveness and efficiency of a program in meeting stated goals and objectives.
Extended Care Service-services in a skilled nursing facility for a condition requiring a lesser level of skilled care than normally provided by a hospital. Such services are provided for a limited duration following a hospital stay.
Facility-a building, including physical plant, equipment and supplies, used in providing health services. Applicable to hospitals, nursing homes, and ambulatory care centers.
Fair Market Value-the price an item would cost in the open market.
Fee for Service-a procedure for charging patients or third-party payers for various services at rates which are determined individually or in accordance with a schedule of fees set by the provider.
Fee Schedule-
1. a provider's fee for service schedule; or
2. a payer's listing of acceptable fees, established allowances, or maximum payments for specified medical procedures.
Fertility Rate-the ratio of the number of births per year to the number of women of child-bearing age.
Financial Feasibility-the determination of a program's ability to, at least, balance operational income and expenses within a given time period. The time period often used is three years, but this varies depending on the specific needs of the institution.
Fixed Costs-costs that do not vary with level of output.
FTE-abbreviation for Full Time Equivalent applied to staffing patterns for positions staffed on a full-time basis or by one or more person on a less than full-time basis. The total hours in a given position expressed as a proportion of the total hours of one full-time person is the quantity of FTE.
Funding Depreciation-an accounting entity set up to account for depreciation.
Governing, Body-the policy making unit of a facility. (see definition for board).
Gross Revenues-the value, at the hospital's full established rates, of services rendered and goods sold to patients during a given time period.
Guideline-a method by which it is determined whether or not a standard has been met.
Handicapped ( Physically)-possessing a physical disability which creates problems in moving about or performing usual physical skills.
Health-includes physical and mental health.
Health Care Facility-a building and/or facility used in the provision of health care, e.g., hospitals and nursing homes.
Health Educator-a person with special training and experience in developing educational programs relating to health for patients, their families, the hospital staff, and the community.
Health Maintenance Organization (HMO)-
1.
a. a system for delivering a broad scope of services to members for a fixed or prenegotiated periodic fee. A public or private organization, organized under the laws of any state, which:
i. is a qualified health maintenance organization under section 1310(d); or
ii. 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;
b. is compensated (except for copayments) for the provision of the basic health care services 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 provides physicians' services primarily directly through physicians who are either employees or partners of such organization, or through arrangements with individual physicians or one or more groups of physicians (organized on a group practice or individual practice basis).
Health Planning Districts-for purposes of Section 1122 Review, there are nine Health Planning Districts which are the defined service areas for certain proposed or existing health care facilities (Refer to map of Health Planning Districts in Chapter 9).
Health Resources-health services, health professions personnel, and health facilities.
High Risk Population-a population group with special vulnerability toward certain diseases or conditions. For example, coal miners are a high risk population for black lung disease.
Home Health Care-health services rendered to an individual as needed in his home rather than in an institution. Such services are provided to aged, disabled, or convalescent individuals by such agencies as a visiting nurse association, a home health agency, hospital or other organized community group.
Hospital-an institution whose primary function is to provide surgical and non-surgical inpatient services, diagnostic and therapeutic, for a variety of medical conditions. Hospitals may provide outpatient services also.
HRA-health Resources Administration, an agency in the Department of Health, Education and Welfare. Responsible for the administration of P.L. 93-641 through its Bureau of Health Planning and Resources Development.
Informed Consent-agreement, usually in writing, obtained from a patient permitting the provider to carry out specific medical, surgical, or research procedures after the purpose, need and risks of the procedure have been fully explained, in non-technical terms.
Inpatient-a patient who has been admitted overnight to a hospital or other health facility for the purpose of receiving medical services.
Institutional Health Services-health services which:
1. are provided through private and public hospitals, rehabilitation facilities, nursing homes, and other health care facilities, as defined by regulation, and
2. entail annual operating costs of at least the 'expenditure minimum' ($75,000).
Intensive Care Unit (ICU)-a specialized unit within a hospital reserved for seriously ill patients needing constant observation and care.
JCAH-Joint Commission of Accreditation of Hospitals.
Lending Institution-institutions such as banks or insurance companies from whom funds are borrowed for short periods for operating needs, or for longer periods for capital needs.
Length of Stay-length of inpatient's stay in a hospital or other health facility, calculated by determining the total number of days in the facility for all discharges and deaths occurring during a period, divided by the number of discharges and deaths during the same period.
Levels of Care-refers to a concept of health care which attempts to organize hospital care on a functional basis which is related to geographic distribution of services. Care is generally defined in three levels:
1. Level I-Provision of services for patients with minor, uncomplicated medical and surgical needs which do not require the support of unusual laboratory or other services;
2. Level II-Provision of services for major health problems which may require the support of unusual laboratory facilities and subspecialist referrals;
3. Level III-Provision of services for complicated and uncomplicated problems. Includes patients with highly complex problems requiring specialized diagnostic procedures, treatment and rehabilitation services. Distinctions between levels of care are largely based on professional training and laboratory procedures, subspecialty referral services, and therapy teams.
Liability-a financial obligation or debt. An obligation shown in the balance sheet in terms of the cost needed to meet it.
License-Permission granted by public, competent authority to an individual or organization to engage in the delivery of health care. Usually granted on the basis of examination and/or education rather than on measures of performance.
Life Support Equipment-specialized equipment in a hospital used to sustain life (e.g., respirator).
Major Medical Equipment-means equipment which is used for the provision of medical and other health services and which costs in excess of $150,000, except that such term does not include medical equipment acquired by or on behalf of a clinical laboratory to provide clinical laboratory services if the clinical laboratory is independent of a physician's office and a hospital and it has been determined under Title XVIII of the Social Security Act to meet the requirements of Paragraphs (10) and (11) of section 1861(s) of such Act. In determining whether medical equipment has a value in excess of $150,000, the value of studies, surveys, designs, plans, working drawings, specifications, and other activities essential to the acquisition of such equipment shall be included.
Manpower Resources-the totality of people involved in the provision of health services.
Medicaid (Title XIX)-a federally aided, state operated and administered program which provides medical benefits for certain low income persons in need of health and medical care. The program is authorized by Title XIX of the Social Security Act.
Medical Staff-collectively, the physicians, dentists, and other professionals responsible for medical care in a health facility, typically a hospital.
Medicare (Title XVIII)-a nationwide health insurance program for people aged 65 and over, for persons eligible for social security disability payments for over two years, and for certain persons who need kidney transplantation or dialysis. It consists of two separate but coordinated programs: hospital insurance (Part A) and supplementary medical insurance (Part B). Blue Cross is the Part A carrier in Louisiana; Pan American Life Insurance Company is the Part B carrier.
Merger-the combination of one or more programs, services, or facilities, usually to create more efficient and effective service delivery.
Neonatal-pertaining to the first four weeks after birth.
Net Equity-the excess of assets over liabilities. An excess of liabilities over assets is known as a deficit in fund balance.
Newborn Nursery-section of the hospital reserved for the care of newborn infants.
Newborn Services-provision of care required by newborn infants.
New Construction-construction where none existed before, as opposed to renovation which involves alteration of existing facilities.
NICU (Neonatal Intensive Care Unit)-a specialized unit within a hospital reserved for seriously ill newborns needing constant observation and care.
Normile Method-a statistical method, based on mathematical probability, for determining the expected range of demand for beds.
Nurse-a person who is especially prepared in the scientific basis of nursing and who meets certain prescribed standards of education and clinical competence. The licensed practical nurse (LPN) is a graduate of a school of practical nursing whose qualifications have been examined by a state board of nursing and who has been legally authorized to practice under the supervision of a physician or registered nurse (RN). The RN is a graduate nurse who has been legally authorized to practice by a similar regulatory authority, and who is legally entitled to use the designation RN.
Nursing Assistant-an individual who performs nursing responsibilities under the supervision of the LPN or RN; does not require licensure.
Patients' Rights-the privilege or claim by patients for involvement in certain aspects of their health care process, including
communication, information and decision-making.
Peak Load-the heaviest demands on a health facility. Generally related to a time period which can be in terms of hours a day, days of a week, or a particular season.
Pediatric Unit-section of a hospital devoted to the care of children, with a usual age limit of 14 years.
Peer Review-generally the evaluation by practicing physicians or other professionals of the care given by other members of their professional category (peers). More recently, it has also referred to the activities of the Professional Standards Review Organizations (PSRO).
Penalty-a financial charge assessed for the non-performance of a contract or obligation.
Perinatal-pertaining to or occuring in the period shortly before and after birth. In medical statistics, generally considered to begin with completion of 28 weeks of gestation and variously defined as ending one to four weeks after birth.
Philanthropy-charitable contribution to a facility. Generally thought of in dollar terms, but may also be conceived in terms of time devoted to governing board or other voluntary activity.
Physician-a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by a State.
P. L. 93-641-the National Health Planning and Resources Development Act of 1974. The act requires the designation of a Health Systems Agency (HSA), a health planning and resources development agency, in each of the health service areas in the U.S., as well as a number of other agencies, councils, and organizations on the area, state and national levels.
P. L. 96-79-the amended National Health Planning and Resources Development Act of 1974.
Postpartum Unit-section of the hospital devoted to the care of mothers after delivery.
Prepayment-meanings include-synonymous with insurance-payment ahead of time to a provider for anticipated services; -payment to an organizational entity (e.g., HMO, foundation for medical care, or prepaid group practice) which provides services as well as mediates the payment mechanism.
Principal-the face value of long-term debt. It is the amount borrowed or owed at a given time period exclusive of interest and other charges.
Proprietary Institution-an institution (hospital, nursing home, etc.) operated for the purpose of making a profit for its owners.
Provider-an individual or organization that provides health care services in exchange for reimbursement from a purchaser.
Provider of Health Care-an individual:
1. who is a direct provider of health care (including a physician, dentist, nurse, podiatrist, optometrist, physician assistant, or ancillary personnel employed under the supervision of a physician) in that the individual's primary current activity is the provision of health care to individuals or the administration of facilities or institutions (including hospitals, long-term care facilities, rehabilitation facilities, alcohol and drug abuse treatment facilities, outpatient facilities, and health maintenance organizations) in which such care is provided and, when required by state law, the individual has received professional training in the provision of such care or in such administration and is licensed or certified for such provision or administration;
2. who holds a fiduciary position with, or has a fiduciary interest in, any entity described in clause ii or iv of Paragraph 3 other than an entity described in such clause which is also an entity described in section 501(c)(3) of the Internal Revenue Code of 1954 and which does not have as its primary purpose the delivery of health care, the conduct of research, the conduct of instruction for health professionals, or the production of drugs or articles described in Clause iii of Paragraph 3;
3. who receives (either directly or through the individual's spouse) more than one-fifth of this gross annual income from any one or combination of:
i. fees or other compensation for research into or instruction in the provision of health care,
ii. entities engaged in the provision of health care or in research or instruction in the provision of health care,
iii. producing or supplying drugs or other articles for individuals or entities for use in the provision of or in research into or instruction in the provision of health care; or
iv. entities engaged in producing drugs or such other articles;
4. who is the member of the immediate family of an individual described in Paragraph 1, 2, 3; or 5 who is engaged in issuing any policy or contract of individual or group health insurance or hospital or medical service benefits. Notwithstanding Paragraph 2, an individual shall not be considered a provider of health care solely because the individual is the member of the governing body of an entity described in clause ii or iv of Paragraph 3.
PSRO (Professional Standards Review Organization)-a physician-sponsored organization charged with comprehensive and on-going review of services provided under the Medicare, Medicaid, and the Maternal and Child Health Programs. The requirement for the establishment of PSRO's was added to the Social Security Amendments of 1972, P. L. 92-603.
Quality Assurance-a program designed to enhance the quality of medical care in a defined setting or program. Includes two major components:
1. a method for identifying deficiencies in care, generally by some form of peer review; and
2. an educational program through which the providers remedy such deficiencies which may be due to organizational, provider, or patient problems.
Quality of Care-medical care that is efficient, effective and efficacious. The term has been difficult to define with precision because of the methodological difficulties associated with the measurement of quality. Quality of care methodology has identified structure, process and outcome as the components of quality.
Quality Review-the methodology of review which may include: outcome and process studies, review of structure (often used in accreditation studies), and peer review. PSRO mandates utilization review (UR) and medical care evaluation (MCE) studies.
Queuing Theory-a statistical method, utilizing mathematical probability, for determining demand. Used to help control fluctuation of demand.
Rehabilitation Facility-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 services which are provided under competent professional supervision.
Reimbursement-payment by third party payers such as Blue Cross, private insurance firms, or government (Medicare, Medicaid, etc.) to facilities which have contracted to pay for the care of covered patients.
Renovation-the alteration and rebuilding of existing facilities. (See new construction)
"1122" Review-a review by SHPDA and HSA's of health facility applications for capital expenditures to determine necessity. Authority for review is legislated by P. L. 94-603, the Social Security Act amendments of 1972.
Reliability-concerned with the consistency or dependability of the measurement. It is directly related to the kinds of data needed for use of the technique in question. Each variable that is added to a given formula has the potential for introducing a certain amount of error and hence the reliability of the technique. All models or formulas are affected by both validity and reliability. (In general, it is helpful to keep in mind that the validity of any given methodology depends on how well the model's assumptions represent reality, or the actual environment in which it is used. In general, the resource and time available to the project as well as the required detail will affect the methodology selected.)
Salvage Value-the value of a capital asset at the end of a specified period. It is the current market price of an asset being considered for replacement.
Section 1122-an amendment to the Social Security Act by P. L. 92603. It provides that payments will not be made under Medicare, Medicaid or the Maternal and Child Health Act with respect to certain disapproved capital expenditures determined to be inconsistent with state or local health plans. P. L. 93-641 requires states participating in the Section 1122 program to have the SHPDA serve as the Section 1122 agency for purposes of required review.
Service Expansion-enlarging the capability of a given service within a health facility.
Service Reduction-reducing the capability of a given service.
Shall-must. The presence of the term "shall" in a standard denotes that the state considers the standard as required for 1122 approval.
SHCC (also LSHCC) (Statewide Health Coordinating Council or Louisiana SHCC)-a council of providers and consumers (who shall be in the majority) appointed by the governor, required under P. L. 93-641 and 96-79. It is responsible for adopting the State Health Plan for review and coordination of the plans and budgets of the HSA's.
Should-ought to. The presence of the term should in a standard denotes that the state considers the standard as highly desirable or as a condition toward which the provider of services should strive in the future.
SHPDA (State Health Planning and Development Agency)-the agency established under P. L. 93-641 in each state. It is responsible for preparing an annual preliminary state health plan, and will also serve as designated review agency for Section 1122 of the Social Security Act.
Social Worker-professionally trained person providing social services, either as a member of a health team, a social service section of a health facility, or on a consultant basis. Social services are provided to enable a patient, family members, or others to deal with problems of social functioning affecting the health or well-being of a patient.
Staffing Plan-a plan, showing how staff responsibilities and relations are organized internally.
Standard-(as a part of "Criteria and Standards") the value, quantitative or qualitative, assigned to a particular criterion.
Start-up Costs-the initial implementation costs incurred by a program before it begins to generate its own revenue.
State Health Plan-a long range plan prepared by the SHPDA and adopted by the SHCC for the state specifying the health goals considered appropriate by the agency and the state health officials and other experts.
Support Services-services required to back up the basic diagnostic and therapeutic skills of the physician. May include laboratory and other services required for patient care.
Surgery Beds-hospital beds reserved for patients requiring surgical procedures.
Surgery Suite-the section of a hospital in which surgical procedures are performed.
Third-Party Payor-the insurer or other agent who pays for some or all of the services provided to a patient. This may be an insurance company, Medicare, Medicaid, CHAMPUS or other coverage or entitlement.
Transfer Agreement-a written document entered into between two institutions (such as a hospital and nursing home) designed to facilitate transfer of patients from one institution to the other.
Underserved-an area in which the ratio of the health providers per thousand population is smaller than some normatively established figure.
Utilization-the extent to which a given group uses a specified service in a specified period of time. Usually expressed as the number of services used per year per 100 or per 1,000 persons eligible for the service, but rates may be expressed in other ratios.
Utilization Review (UR)-evaluation of the necessity, appropriateness and efficiency of the use of medical services, procedures, and facilities. In a hospital this may include review of appropriateness of admissions, services ordered and provided, length of stay, and discharge ctices. Medicare and Medicaid require as a condition of participation that hospitals have a utilization review committee in operation.
Validity-the ability of a technique to measure accurately the phenomenon which it purports to measure. (The critical question is whether or not a given technique adequately incorporates the variables which influence the number of beds needed)
Variable Costs-costs which generally increase or decrease as the size and composition of the enrollment fluctuates.
Working Capital-the sum of an institution's investment in short-term or current assets. Net working capital is the excess of total current assets over total current liabilities.
AUTHORITY NOTE: Promulgated in accordance with P. L. 93-641 amended by P.L. 96-79, and R.S. 36:256(b).
