Current through 2024-38, September 18, 2024
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.
