Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › GENERAL PROVISIONS › Section 915.3 - 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).
Category
-A specifically defined, mutually
					 exclusive division in a classification system.
Cell
-The smallest unit or compartment of
					 a statistical table or tabulation.
Council
-The Health Care Cost Containment
					 Council.
Data
or
raw data
-Data
					 collected by the Council or the Council's data vendor under section 6 of the
					 act (35 P. S. §
											449.6).
Data source
-The term includes, but is not
					 limited to, the following:
(i) A
				  hospital.
(ii) An ambulatory
				  service facility.
(iii) A
				  physician.
(iv) A health
				  maintenance organization as the term is defined in the Health Maintenance
				  Organization Act (40 P. S. §§
											1551-1567).
(v) A hospital, medical or health service
				  plan with a certificate of authority issued by the Insurance Department,
				  including, but not limited to, hospital plan corporations as defined in 40
				  Pa.C.S. Chapter 61 (relating to hospital plan corporations) and professional
				  health service plan corporations as defined in 40 Pa.C.S. Chapter 63 (relating
				  to professional health services plan corporations).
(vi) A commercial insurer with a certificate
				  of authority issued by the Insurance Department providing health or accident
				  insurance.
(vii) A self-insured
				  employer providing health or accident coverage or benefits for employes
				  employed in this Commonwealth.
(viii) An administrator of a self-insured or
				  partially self-insured health or accident plan providing covered services in
				  this Commonwealth.
(ix) A health
				  and welfare fund that provides health or accident benefits or insurance
				  pertaining to covered services in this Commonwealth.
(x) The Department of Public Welfare for
				  those covered services it purchases or provides through the Medical Assistance
				  program under the Public Welfare Code (62 P. S. §§
											101-1411).
(xi) Other payors for covered services in
				  this Commonwealth, other than an individual.
Executive Director
-The Executive Director
					 of the Council.
Nondisclosable data
-Data pertaining to an
					 individual's health care service encounter that, if disclosed, violate the
					 provisions concerning release of and access to Council data contained in the
					 act. These data are set forth in Appendix A.
Nonprotected data
-Data pertaining to an
					 individual's health care service encounter that may be released by the Council
					 without violating provisions concerning release of and access to Council data
					 contained in the act. These data are set forth in Appendix C.
Other parties
-Entities other than
					 purchasers to which the Council may release data under the act.
Protected data
-Data pertaining to an
					 individual's health care service encounter that may only be released by the
					 Council under the act in specific circumstances based on criteria developed by
					 the Council. These data are set forth in Appendix B.
Proxy patient identifier
-A unique number
					 assigned by the Council to an individual patient which will not breech patient
					 confidentiality provisions contained in the act or in this chapter.
Purchaser
-A corporation, labor
					 organization or other entity that purchases benefits which provide covered
					 services for employes or members, either through a health care insurer or by
					 means of a self-funded program of benefits, and a certified bargaining
					 representative that represents groups of employes for whom employers purchase a
					 program of benefits which provide covered services. The term does not include
					 entities defined in the act as "health care insurers."