Washington Administrative Code › Title 246 - Health, Department of › HEALTH INFORMATION › Chapter 246-453 - Hospital charity care › Section 246-453-010 - Definitions

Current through Register Vol. 24-14, July 15, 2024
As used in this chapter, unless the context requires
				  otherwise,
(1) "Department" means the
				Washington state department of health created by
				chapter
				43.70 RCW;
(2) "Hospital" means any health care
				institution which is required to qualify for a license under
				RCW
				 70.41.020(2); or as a
				psychiatric hospital under
				chapter
				71.12 RCW;
(3) "Manual" means the
Washington
				State Department of Health Accounting and Reporting Manual for
				Hospitals
, adopted under WAC
				246-454-020;
(4) "Indigent persons" means those patients
				who have exhausted any third-party sources, including medicare and medicaid,
				and whose income is equal to or below 200% of the federal poverty standards,
				adjusted for family size or is otherwise not sufficient to enable them to pay
				for the care or to pay deductibles or coinsurance amounts required by a
				third-party payor;
(5) "Charity
				care" means appropriate hospital-based medical services provided to indigent
				persons, as defined in this section;
(6) "Bad debts" means uncollectible amounts,
				excluding contractual adjustments, arising from failure to pay by patients
				whose care has not been classified as charity care;
(7) "Appropriate hospital-based medical
				services" means those hospital services which are reasonably calculated to
				diagnose, correct, cure, alleviate, or prevent the worsening of conditions that
				endanger life, or cause suffering or pain, or result in illness or infirmity,
				or threaten to cause or aggravate a handicap, or cause physical deformity or
				malfunction, and there is no other equally effective more conservative or
				substantially less costly course of treatment available or suitable for the
				person requesting the service. For purpose of this section, "course of
				treatment" may include mere observation or, where appropriate, no treatment at
				all;
(8) "Medical staff" means
				physicians, dentists, nurses, and other professional individuals who have
				admitting privileges to the hospital, and may also participate as members of
				the medical staff committees, serve as officers of the medical staff, and serve
				as directors or chiefs of hospital departments;
(9) "Third-party coverage" and "third-party
				sponsorship" means an obligation on the part of an insurance company or
				governmental program which contracts with hospitals and patients to pay for the
				care of covered patients and services, and may include settlements, judgments,
				or awards actually received related to the negligent acts of others which have
				resulted in the medical condition for which the patient has received hospital
				services;
(10) "Unusually costly or
				prolonged treatment" means those services or combinations of services which
				exceed two standard deviations above the average charge, and/or three standard
				deviations above the average length of stay, as determined by the department's
				discharge data base;
(11)
				"Emergency care or emergency services" means services provided for care related
				to an emergency medical or mental condition;
(12) "Emergency department" and "emergency
				room" means that portion of the hospital facility organized for the purpose of
				providing emergency care or emergency services;
(13) "Emergency medical condition" means a
				medical condition manifesting itself by acute symptoms of sufficient severity,
				including severe pain, such that the absence of immediate medical attention
				could reasonably be expected to result in:
(a)
				Placing the health of the individual (or, with respect to a pregnant woman, the
				health of the woman or her unborn child) in serious jeopardy;
(b) Serious impairment of bodily
				functions;
(c) Serious dysfunction
				of any bodily organ or part.
With respect to a pregnant woman who is having contractions
				  the term shall mean:
(d)
				That there is inadequate time to effect a safe transfer to another hospital
				before delivery; or
(e) That
				transfer may pose a threat to the health or safety of the woman or the unborn
				child;