Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 405.000 - Community Health Center Services › Section 405.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130 CMR
				405.000 have the meanings given in
				130
				CMR 405.402, unless the context clearly
				requires a different meaning. The reimbursability of services defined in
				130 CMR
				405.000 is not determined by these definitions, but by
				application of
				130 CMR
				405.000, and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
.
340B Covered Entities
- facilities and
				programs eligible to purchase discounted drugs through a program established by
				Public Law
				102-585,
				§
									340B of the Veterans Health Act of
				1992.
340B Drug Pricing Program
- a program
				established by Public Law
				102-585,
				§
									340B of the Veterans Health Act of
				1992.
Acupuncture - the insertion of metal needles through the skin
				at certain points on the body, with or without the use of herbs, with or
				without the application of an electric current, and with or without the
				application of heat to the needles, skin, or both.
Family Practitioner
- a licensed
				physician who is board-eligible or board-certified in family practice. A family
				practitioner provides continuous, accessible medical care with emphasis on the
				family unit that combines appreciation of both the biomedical and psychosocial
				dimensions of illness. The family practitioner assumes responsibility for and
				provides most of the member's health care, and coordinates the member's total
				health needs.
Family Therapy
- a session for
				simultaneous treatment of two or more members of a family.
Freestanding Clinic
- any institution
				licensed as a clinic by the Massachusetts Department of Public Health pursuant
				to M.G.L. c. 111, § 51 that is not part of a hospital and that possesses
				its own legal identity, maintains its own patient records, and administers its
				own budget and personnel. Such institutions include CHCs and mental health
				centers.
Gross Cost Per Utilizer Per Year
-
				annual cost per utilizer projected by EOHHS based on factors including actual
				or expected utilization, dosing information, duration of therapy, and the
				National average Drug Acquisition Cost (NADAC) or Wholesale Acquisition Cost
				(WAC) (when NADAC is not available) of the covered drug prior to any federal or
				supplemental rebate.
Group Clinic Visit
- a session
				conducted by a physician, physician assistant, certified nurse practitioner,
				clinical nurse specialist, or registered nurse to introduce preventive medicine
				approaches to personal health and safety and to present self help and personal
				management information concerning family medicine, adult medicine, sex
				education, and chronic illness. Tobacco cessation group clinic visits may be
				provided by MassHealth-qualified tobacco cessation counseling providers as
				defined in
				130
				CMR 405.472.
Group Therapy
- application of
				psychotherapeutic or counseling techniques to a group of persons, most of whom
				are not related by blood, marriage, or legal guardianship.
Health Practitioner
- an individual
				who can diagnose and treat medical problems whether by authority of his or her
				own license or by the delegated authority of a licensed medical
				professional.
HIV Post-test Counseling Visit
- a
				face-to-face meeting at the CHC between the member and a physician, physician
				assistant, certified nurse practitioner, clinical nurse specialist, registered
				nurse, or counselor (working under the supervision of one of the
				aforementioned) for the purpose of providing counseling after HIV testing. Such
				counseling will include information about the implications of positive and
				negative test results, risk-reduction techniques, partner notification, and
				referral to medical and support services, in accordance with established
				protocols of the Massachusetts Department of Public Health.
HIV Pre-test Counseling Visit
- a
				face-to-face meeting at the CHC between the member and a physician, physician
				assistant, certified nurse practitioner, clinical nurse specialist, registered
				nurse, or counselor (working under the supervision of one of the
				aforementioned) for the purpose of providing counseling before HIV testing.
				Providers will offer information on risk factors and implications of both
				positive and negative test results, in accordance with established protocols of
				the Massachusetts Department of Public Health.
Home Visit
- a face to face meeting
				between a member and a physician, physician assistant, certified nurse
				practitioner, clinical nurse specialist, or registered nurse in the member's
				residence for examination, diagnosis, or treatment.
Hospital Visit
- a face to face
				meeting between a member and a physician, physician assistant, certified nurse
				practitioner, clinical nurse specialist, or registered nurse when the member
				has been admitted to a hospital by a physician on the CHC's staff.
Individual Medical Visit
- a face to
				face meeting at the CHC between a member and a physician, physician assistant,
				certified nurse practitioner, clinical nurse specialist, or registered nurse
				for medical examination, diagnosis, or treatment.
Individual Mental Health Visit
- a
				face-to-face meeting at the CHC between a patient and either a psychiatrist or
				an advanced practice registered nurse (APRN) with a graduate degree and
				advanced training in psychiatric care (a psychiatric clinical nurse specialist
				or a psychiatric mental health nurse practitioner) within the community health
				center setting, for purposes of examination, diagnosis, or treatment.
Individual Therapy
- psychotherapeutic
				services provided to an individual.
Institutionalized Individual
- for
				purposes of
				130 CMR
				405.428 through
				405.430,
				an individual who is
(1) involuntarily
			 confined or detained, under a civil or criminal statute in a correctional or
			 rehabilitative facility, including a psychiatric hospital or other facility for
			 the care and treatment of mental illness; or
(2) confined, under a voluntary commitment,
			 in a psychiatric hospital or other facility for the care and treatment of
			 mental illness.
Mentally Incompetent Individual
- for
				purposes of
				130 CMR
				405.428 through
				405.430,
				an individual who has been declared mentally incompetent by a federal, state,
				or local court of competent jurisdiction for any purpose, unless the individual
				has been declared competent for purposes that include the ability to consent to
				sterilization.
Nursing Facility Visit
- a visit by a
				physician, physician assistant, certified nurse practitioner, clinical nurse
				specialist, or registered nurse to a member who has been admitted to a nursing
				facility, extended care facility, or convalescent or rest home.
Primary or Elective Care
- medical
				care required by individuals or families that is appropriate for the
				maintenance of health and the prevention of illness. This care includes, but is
				not limited to, physical examination, diagnosis and management of illness,
				ongoing health maintenance, accident prevention and referral when necessary.
				This care does not require the specialized resources of a hospital emergency
				department.
Psychological Testing
- the use of
				standardized test instruments to evaluate aspects of an individual's
				functioning, including aptitudes, educational achievements, cognitive
				processes, emotional conflicts, and type and degree of psychopathology.
Sterilization
- any medical procedure,
				treatment, or operation for the purpose of rendering an individual permanently
				incapable of reproducing.
Urgent Care
- medical services
				required promptly to prevent impairment of health due to symptoms that a
				prudent lay person would believe require medical attention, but are not
				life-threatening and do not pose a high risk of permanent damage to an
				individual's health. Urgent care does not include elective or primary
				care.