Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 230 - STATE MEDICAL FACILITIES PLAN › Part I - Definitions and General Information › Section 12VAC5-230-10 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter
					 shall have the following meanings unless the context clearly indicates
					 otherwise:
"Acute psychiatric services" means hospital-based inpatient
					 psychiatric services provided in distinct inpatient units in general hospitals
					 or freestanding psychiatric hospitals.
"Acute substance abuse disorder treatment services" means
					 short-term hospital-based inpatient treatment services with access to the
					 resources of (i) a general hospital, (ii) a psychiatric unit in a general
					 hospital, (iii) an acute care addiction treatment unit in a general hospital
					 licensed by the Department of Health, or (iv) a chemical dependency specialty
					 hospital with acute care medical and nursing staff and life support equipment
					 licensed by the Department of Behavioral Health and Developmental
					 Services.
"Bassinet" means an infant care station, including warming
					 stations and isolettes.
"Bed" means that unit, within the complement of a medical
					 care facility, subject to COPN review as required by Article 1.1 (§
										32.1-102.1 et seq.)
					 of the Code of Virginia and designated for use by patients of the facility or
					 service. For the purposes of this chapter, bed does include cribs and bassinets
					 used for pediatric patients but does not include cribs and bassinets in the
					 newborn nursery or neonatal special care setting.
"Cardiac catheterization" means an invasive procedure where
					 a flexible tube is inserted into the patient through an extremity blood vessel
					 and advanced under fluoroscopic guidance into the heart chambers or coronary
					 arteries. A cardiac catheterization may be conducted for diagnostic or
					 therapeutic purposes but does not include a simple right heart catheterization
					 for monitoring purposes as might be performed in an electrophysiology
					 laboratory, pulmonary angiography as an isolated procedure, or cardiac pacing
					 through a right electrode catheter.
"Commissioner" means the State Health Commissioner.
"Competing applications" means applications for the same or
					 similar services and facilities that are proposed for the same health planning
					 district, or same health planning region for projects reviewed on a regional
					 basis, and are in the same batch review cycle.
"Complex therapeutic cardiac catheterization" means the
					 performance of cardiac catheterization for the purpose of correcting or
					 improving certain conditions that have been determined to exist in the heart or
					 great arteries or veins of the heart, specifically catheter-based procedures
					 for structural treatment to correct congenital or acquired structural or
					 valvular abnormalities.
"Computed tomography" or "CT" means a noninvasive
					 diagnostic technology that uses computer analysis of a series of
					 cross-sectional scans made along a single axis of a bodily structure or tissue
					 to construct an image of that structure.
"Continuing care retirement community" or "CCRC" means a
					 retirement community consistent with the requirements of Chapter 49 (§
										38.2-4900 et seq.) of
					 Title 38.2 of the Code of Virginia.
"COPN" means a Medical Care Facilities Certificate of
					 Public Need for a project as required in Article 1.1 (§
										32.1-102.1 et seq.)
					 of Chapter 4 of Title 32.1 of the Code of Virginia.
"COPN program" means the Medical Care Facilities
					 Certificate of Public Need Program implementing Article 1.1 (§
										32.1-102.1 et seq.)
					 of Chapter 4 of Title 32.1 of the Code of Virginia.
"DEP" means diagnostic equivalent procedure, a method for
					 weighing the relative value of various cardiac catheterization procedures as
					 follows: a diagnostic cardiac catheterization equals 1 DEP, a simple
					 therapeutic cardiac catheterization equals 2 DEPs, a same session procedure
					 (diagnostic and simple therapeutic) equals 3 DEPs, and a complex therapeutic
					 cardiac catheterization equals 5 DEPs. A multiplier of 2 will be applied for a
					 pediatric procedure (i.e., a pediatric diagnostic cardiac catheterization
					 equals 2 DEPs, a pediatric simple therapeutic cardiac catheterization equals 4
					 DEPs, and a pediatric complex therapeutic cardiac catheterization equals 10
					 DEPs.)
"Diagnostic cardiac catheterization" means the performance
					 of cardiac catheterization for the purpose of detecting and identifying defects
					 in the great arteries or veins of the heart or abnormalities in the heart
					 structure, whether congenital or acquired.
"Direction" means guidance, supervision, or management of a
					 function or activity.
"Gamma knife®" means the name of a specific instrument
					 used in stereotactic radiosurgery.
"Health planning district" means the same contiguous areas
					 designated as planning districts by the Virginia Department of Housing and
					 Community Development or its successor.
"Health planning region" means a contiguous geographic area
					 of the Commonwealth as designated by the State Board of Health with a
					 population base of at least 500,000 persons, characterized by the availability
					 of multiple levels of medical care services, reasonable travel time for
					 tertiary care, and congruence with planning districts.
"Health system" means an organization of two or more
					 medical care facilities, including hospitals, that are under common ownership
					 or control and are located within the same health planning district, or health
					 planning region for projects reviewed on a regional basis.
"Hospital" means a medical care facility licensed as an
					 inpatient hospital or outpatient surgical center by the Department of Health or
					 as a psychiatric hospital by the Department of Behavioral Health and
					 Developmental Services.
"ICF/MR" means an intermediate care facility for the
					 mentally retarded.
"Indigent" means any person whose gross family income is
					 equal to or less than 200% of the federal Nonfarm Poverty Level or income
					 levels A through E of
					 12VAC5-200-10 and who
					 is uninsured.
"Inpatient" means a patient who is hospitalized longer than
					 24 hours for health or health related services.
"Intensive care beds" or "ICU" means inpatient beds located
					 in the following units or categories:
1. General intensive care units are those units where
					 patients are concentrated by reason of serious illness or injury regardless of
					 diagnosis. Special lifesaving techniques and equipment are immediately
					 available and patients are under continuous observation by nursing
					 staff;
2. Cardiac care units, also known as Coronary Care Units or
					 CCUs, are units staffed and equipped solely for the intensive care of cardiac
					 patients; and
3. Specialized intensive care units are any units with
					 specialized staff and equipment for the purpose of providing care to seriously
					 ill or injured patients based on age selected categories of diagnoses,
					 including units established for burn care, trauma care, neurological care,
					 pediatric care, and cardiac surgery recovery but does not include bassinets in
					 neonatal special care units.
"Lithotripsy" means a noninvasive therapeutic procedure to
					 (i) crush renal and biliary stones using shock waves (i.e., renal lithotripsy)
					 or (ii) treat certain musculoskeletal conditions and relieve the pain
					 associated with tendonitis (i.e., orthopedic lithotripsy).
"Long-term acute care hospital" or "LTACH" means an
					 inpatient hospital that provides care for patients who require a length of stay
					 greater than 25 days and is, or proposes to be, certified by the Centers for
					 Medicare and Medicaid Services as a long-term care inpatient hospital pursuant
					 to 42 CFR Part 412. An LTACH may be either a freestanding facility or located
					 within an existing or host hospital.
"Magnetic resonance imaging" or "MRI" means a noninvasive
					 diagnostic technology using a nuclear spectrometer to produce electronic images
					 of specific atoms and molecular structures in solids, especially human cells,
					 tissues and organs.
"Medical rehabilitation" means those services provided
					 consistent with 42 CFR 412.23.
"Medical/surgical" means those services available for the
					 care and treatment of patients not requiring specialized services.
"Minimum survival rates" means the base percentage of
					 transplant recipients who survive at least one year or for such other period of
					 time as specified by the United Network for Organ Sharing (UNOS).
"Neonatal special care" means care for infants in one or
					 more of the higher service levels designated in
					 12VAC5-410-443.
"Nursing facility" means those facilities or components
					 thereof licensed to provide long-term nursing care.
"Obstetrical services" means the distinct organized
					 program, equipment and care related to pregnancy and the delivery of newborns
					 in inpatient facilities.
Off-site replacement" means the relocation of existing beds
					 or services from an existing medical care facility site to another location
					 within the same health planning district.
"Open heart surgery" means a surgical procedure requiring
					 the use or immediate availability of a heart-lung bypass machine or "pump." The
					 use of the pump during the procedure distinguishes "open heart" from "closed
					 heart" surgery.
"Operating room" means a room used solely or principally
					 for the provision of surgical procedures involving the administration of
					 anesthesia, multiple personnel, recovery room access, and a fully controlled
					 environment.
"Operating room use" means the amount of time a patient
					 occupies an operating room and includes room preparation and cleanup
					 time.
"Operating room visit" means one session in one operating
					 room in an inpatient hospital or outpatient surgical center, which may involve
					 several procedures. Operating room visit may be used interchangeably with
					 "operation" or "case."
"Outpatient" means a patient who visits a hospital, clinic,
					 or associated medical care facility for diagnosis or treatment, but is not
					 hospitalized 24 hours or longer.
"Pediatric" means patients younger than 18 years of age.
					 Newborns in nurseries are excluded from this definition.
"Perinatal services" means those resources and capabilities
					 that all hospitals offering general level newborn services as described in
					 12VAC5-410-443
					 must provide routinely to newborns.
"PET/CT scanner" means a single machine capable of
					 producing a PET image with a concurrently produced CT image overlay to provide
					 anatomic definition to the PET image. For the purpose of granting a COPN, the
					 State Board of Health pursuant to §
										32.1-102.2A
					 6 of the Code of Virginia has designated PET/CT as a specialty clinical
					 service. A PET/CT scanner shall be reviewed under the PET criteria as an
					 enhanced PET scanner unless the CT unit will be used independently. In such
					 cases, a PET/CT scanner that will be used to take independent PET and CT images
					 will be reviewed under the applicable PET and CT services criteria.
"Planning horizon year" means the particular year for which
					 bed or service needs are projected.
"Population" means the census figures shown in the most
					 current series of projections published by a demographic entity as determined
					 by the commissioner.
"Positron emission tomography" or "PET" means a noninvasive
					 diagnostic or imaging modality using the computer-generated image of local
					 metabolic and physiological functions in tissues produced through the detection
					 of gamma rays emitted when introduced radionuclides decay and release
					 positrons. A PET device or scanner may include an integrated CT to provide
					 anatomic structure definition.
"Primary service area" means the geographic territory from
					 which 75% of the patients of an existing medical care facility originate with
					 respect to a particular service being sought in an application.
"Procedure" means a study or treatment or a combination of
					 studies and treatments identified by a distinct ICD-10 or CPT code performed in
					 a single session on a single patient.
"Qualified" means meeting current legal requirements of
					 licensure, registration, or certification in Virginia or having appropriate
					 training, including competency testing, and experience commensurate with
					 assigned responsibilities.
"Radiation therapy" means treatment using ionizing
					 radiation to destroy diseased cells and for the relief of symptoms. Radiation
					 therapy may be used alone or in combination with surgery or
					 chemotherapy.
"Relevant reporting period" means the most recent 12-month
					 period, prior to the beginning of the applicable batch review cycle, for which
					 data is available from VHI or a demographic entity as determined by the
					 commissioner.
"Rural" means territory, population, and housing units that
					 are classified as "rural" by the Bureau of the Census of the U.S. Department of
					 Commerce, Economic and Statistics Administration.
"Simple therapeutic cardiac catheterization" means the
					 performance of cardiac catheterization for the purpose of correcting or
					 improving certain conditions that have been determined to exist in the heart,
					 specifically catheter-based treatment procedures for relieving coronary artery
					 narrowing.
"SMFP" means the state medical facilities plan as contained
					 in Article 1.1 (§
										32.1-102.1 et seq.)
					 of Chapter 4 of Title 32.1 of the Code of Virginia used to make medical care
					 facilities and services needs decisions.
"Stereotactic radiosurgery" or "SRS" means the use of
					 external radiation in conjunction with a stereotactic guidance device to very
					 precisely deliver a therapeutic dose to a tissue volume. SRS may be delivered
					 in a single session or in a fractionated course of treatment up to five
					 sessions.
"Stereotactic radiotherapy" or "SRT" means more than one
					 session of stereotactic radiosurgery.
"Substance abuse disorder treatment services" means
					 services provided to individuals for the prevention, diagnosis, treatment, or
					 palliation of chemical dependency, which may include attendant medical and
					 psychiatric complications of chemical dependency. Substance abuse disorder
					 treatment services are licensed by the Department of Behavioral Health and
					 Developmental Services.
"Supervision" means to direct and watch over the work and
					 performance of others.
"Use rate" means the rate at which an age cohort or the
					 population uses medical facilities and services. The rates are determined from
					 periodic patient origin surveys conducted for the department by the regional
					 health planning agencies or other health statistical reports authorized by
					 Chapter 7.2 (§
										32.1-276.2
					 et seq.) of Title 32.1 of the Code of Virginia.
"VHI" means the health data organization defined in §
										32.1-276.4
					 of the Code of Virginia and under contract with the Virginia Department of
					 Health.
Statutory Authority: §§
												32.1-12
						and
						32.1-102.2 of the
						Code of Virginia.