Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter A - GENERAL PROVISIONS › Section 912.3 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise:
Act
-The Health Care Cost Containment Act
					 (35
					 P. S. §§
											449.1-449.19).
Additional data elements
-Data,
					 redefinitions of data or methodologies to calculate data to be added to the
					 Pennsylvania Uniform Claims and Billing Form format.
Ambulatory service facility
-A facility
					 licensed in this Commonwealth, not part of a hospital, which provides medical,
					 diagnostic or surgical treatment to patients not requiring hospitalization. The
					 term includes, but is not limited to, ambulatory surgical facilities,
					 ambulatory imaging or diagnostic centers, birthing centers, free-standing
					 emergency rooms and other facilities providing ambulatory care which charge a
					 separate facility charge. The term does not include the offices of private
					 physicians or dentists, whether for individual or group practices.
Charge
-The amount billed by a provider
					 for specific goods or services provided to a patient, prior to adjustment for
					 contractual allowances.
Council
-The Health Care Cost Containment
					 Council.
Covered services
-Health care services or
					 procedures connected with episodes of illness that require either inpatient
					 hospital care or major ambulatory service, such as surgical, medical or major
					 radiological procedures, including initial and follow-up outpatient services
					 associated with the episode of illness before, during or after inpatient
					 hospital care or major ambulatory service. The term does not include routine
					 outpatient services connected with episodes of illness that do not require
					 hospitalization or major ambulatory service.
Data elements
-Data identified by the
					 Council to be submitted to the Council as part of the Pennsylvania Uniform
					 Claims and Billing Form format.
Executive Director
-The Executive Director
					 of the Council.
General hospital
-A hospital equipped and
					 staffed for the treatment of medical or surgical conditions, or both, in the
					 acute or chronic stages, on an inpatient basis of 24 or more hours. The term
					 includes hospitals that treat children as their specialty.
Health care facility
-The term includes
					 the following:
(i) A general or
				  special hospital, including tuberculosis and psychiatric hospitals.
(ii) Ambulatory service facilities as defined
				  in this section.
Hospital
-An institution, licensed in this
					 Commonwealth, which is a general, tuberculosis, mental, chronic disease or
					 other type of hospital, or kidney disease treatment center, whether profit or
					 nonprofit, including those operated by an agency of State or local
					 government.
Major ambulatory service
-Surgical or
					 medical procedures, including diagnostic and therapeutic radiological
					 procedures, commonly performed in hospitals or ambulatory service facilities,
					 which are not of a type commonly performed or which cannot be safely performed
					 in physicians' offices and which require special facilities, such as operating
					 rooms or suites or special equipment, such as fluoroscopic equipment or
					 computed tomographic scanners, or a postprocedure recovery room or short term
					 convalescent room.
Pennsylvania Uniform Claims and Billing Form
					 format
-The Uniform Hospital Billing Form UB-82/HCFA-1450, and the HCFA
					 1500, or their successors, as developed by the National Uniform Billing
					 Committee, with additional fields as necessary to provide the data in section
					 6(c) and (d) of the act (35 P. S. §
											449.6(c) and (d)).
Physician
-An individual licensed under
					 the laws of the Commonwealth to practice medicine and surgery within the scope
					 of the Osteopathic Medical Practice Act (63 P. S.
					 §§
											271.1-271.18) or the Medical
					 Practice Act of 1985 (63 P. S. §§
											422.1-422.45).
Provider
-A hospital, ambulatory service
					 facility or physician.
Provider quality
-The extent to which a
					 provider renders care that, within the capabilities of modern medicine, obtains
					 for patients medically acceptable health outcomes and prognoses, adjusted for
					 patient severity, and treats patients compassionately and responsively.
Provider service effectiveness
-The
					 effectiveness of services rendered by a provider, determined by measurement of
					 the medical outcome of patients grouped by severity receiving those
					 services.
Raw data
or
data
-Data
					 collected by the Council under section 6 of the act in the form initially
					 received.
Region
-A geographical area of contiguous
					 counties formed to provide a basis for implementing data collection activities
					 and reporting according to the following:
(i) Region 1 (Western Southwest)-Allegheny,
				  Armstrong, Beaver, Fayette, Green, Washington and Westmoreland
				  Counties.
(ii) Region 2
				  (Northwest)-Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest,
				  Jefferson, Lawrence, McKean, Mercer, Potter, Venango and Warren
				  Counties.
(iii) Region 3 (Eastern
				  Southwest)-Bedford, Blair, Cambria, Indiana and Somerset Counties.
(iv) Region 4 (North Central)-Centre,
				  Clinton, Columbia, Lycoming, Mifflin, Montour, Northumberland, Snyder, Tioga
				  and Union Counties.
(v) Region 5
				  (South Central)-Adams, Cumberland, Dauphin, Franklin, Fulton, Huntingdon,
				  Juniata, Lancaster, Lebanon, Perry and York Counties.
(vi) Region 6 (Northeast)-Bradford,
				  Lackawanna, Luzerne, Monroe, Pike, Sullivan, Susquehanna, Wayne and Wyoming
				  Counties.
(vii) Region 7
				  (Eastern)-Berks, Carbon, Lehigh, Northampton and Schuylkill Counties.
(viii) Region 8 (Suburban Southeast)-Bucks,
				  Chester, Delaware and Montgomery Counties.
(ix) Region 9
				  (Southeast-Philadelphia)-Philadelphia County.
Short term procedure unit
-A unit
					 organized for the delivery of nonemergency surgical services to patients who do
					 not remain in the hospital overnight.
Special hospital
-A hospital equipped and
					 staffed for the treatment of disorders within the scope of specific medical
					 specialties or for the treatment of limited classifications of diseases in
					 their acute or chronic stages on an inpatient basis of 24 or more hours. The
					 term includes psychiatric and rehabilitation hospitals.
Specialty unit
-A functional unit of a
					 hospital that provides drug and alcohol rehabilitation, rehabilitative and
					 psychiatric services.
The provisions of this §
												912.3 amended under section 5(b)
						of the Health Care Cost Containment Act (35 P. S. §
													449.5(b)).