Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 41.00 - RATES OF PAYMENT FOR SERVICES PROVIDED TO INDUSTRIAL ACCIDENT PATIENTS BY HOSPITALS › Section 41.02 - Definitions

Current through Register 1525, July 5, 2024
Meaning of Terms
. As used in 114.1 CMR
				41.00, unless the context requires otherwise, terms shall have the meanings set
				forth in 114.1 CMR 41.02:
Acute Hospital
. A Hospital licensed
				under M.G.L. c. 111, § 51, which contains a majority of medical-surgical,
				pediatric, obstetric, and maternity beds, as defined by the Department of
				Public Health.
Acute Median Payment on Account
				Factor
. The median of all Payment on Account Factors determined
				for each Acute Hospital.
Base Year
. The Hospital fiscal year
				for which DHCFP-403 data is used to compute the Payment on Account Factor. Only
				data from a complete or non-partial fiscal year is used in the computation of
				the Payment on Account Factor. If the Division determines that the data source
				is inadequate or not representative of the Hospital's ongoing costs, the
				Division may consider alternative data sources to determine Base Year costs.
				Criteria for such review will include but shall not be limited to peer group
				analysis.
Charge
. A Hospital's uniform price for
				each specific service within a revenue center as filed with the
				Division.
DHCFP-403
. The Hospital Statement of
				Costs, Revenues and Statistics.
Division
. The Division of Health Care
				Finance and Policy as established under M.G.L. c. 118G.
Governmental Unit
. The Commonwealth,
				any division, department, agency, board or commission of the Commonwealth, and
				any political subdivision of the Commonwealth.
Gross Patient Service Revenue
. The
				total dollar amount of a Hospital's Charges for services rendered in a fiscal
				year.
Health Safety Net
. The fund
				established under M.G.L. c. 118G, § 36 to pay Acute Hospitals and community
				health centers for health services provided to low-income uninsured and under
				insured individuals.
Hospital
. An Acute Hospital or a
				Non-acute Hospital
Hospital Uniform Assessment
				Percentage
. Massachusetts Acute Hospitals' liability to the Health
				Safety Net, expressed as a percentage of statewide Acute Hospital private
				sector revenue. An individual Acute Hospital's gross liability to the Health
				Safety Net equals the Hospital Uniform Assessment Percentage multiplied by that
				Hospital's gross private sector Charges.
Implanted Durable Medical Equipment
				(DME)
. Implanted prosthetic devices, replacement parts (external
				or internal), accessories and supplies for implanted DME.
Industrial Accident Patient
. A person
				who receives services for which an employer or insurer is in whole or part
				liable under M.G.L. c. 152, the Workers' Compensation Act.
New Hospital
. A Hospital that was not
				licensed and operated as a Hospital in the base year or which did not report a
				full year of data for that year.
Non-acute Median Payment on Account
				Factor
. The median of all Payment on Account Factors determined
				for each Non-acute Hospital.
Non-acute Hospital
. A Hospital that is
				defined and licensed under M.G.L. c. 111, § 51, with less than a majority of
				medical-surgical, pediatric, maternity and obstetric beds, or any psychiatric
				facility licensed under M.G.L. c. 19, §19, or any public health care
				facility.
Observation Services
. Outpatient
				services ordered by a physician that consist of intermittent monitoring by
				professional licensed staff that are reasonable and necessary to evaluate a
				patient's condition to determine the potential need for admission to the
				hospital.
Payment on Account Factor (PAF)
. The
				percentage applied to total Charges for services rendered to an Industrial
				Accident Patient to calculate payment as determined in accordance with 114.1
				CMR 41.03.
Private Sector GPSR
. Total Hospital
				Charges attributable to Industrial Accident, Managed Care and Non-managed Care
				payer groups.
Public Health Care Facility
. A
				facility operated by the Department of Public Health, the Department of Mental
				Health or a County of the Commonwealth.
Rate Year
. For all Hospitals, the
				fiscal year beginning October 1st.
Rehabilitation Services
. Comprehensive
				services performed to achieve objectives of improved health and welfare with
				the realization of optimal physical, social and vocational potential.
Restorative Services
. Physical Therapy
				(PT), Occupational Therapy (OT) or Speech Therapy (ST) services rendered for
				maximum reduction of physical and/or speech disability and restoration of
				optimal functionality.
Speech/Language Pathology Services
.
				The evaluation and treatment of communicative disorders of articulation
				(including aphasia and dysarthria, language, voice and
				fluency).