35 Pa. Stat. § 10227.102

Current through Pa Acts 2024-35, 2024-56
Section 10227.102 - Definitions

The following words and phrases when used in this chapter shall have the meanings given to them in this section unless the context clearly indicates otherwise:

"Chronic care and disease management." A model of care that includes the following:

(1) The provision of effective health management through support and information that also promotes patient self-care for patients with chronic conditions.

(2) The use of evidence-based medicine to ensure appropriate treatment decisions by health care providers.

(3) The coordination of care and use of reasonably accessible and updated patient information that encourages follow-up care as a standard procedure.

(4) The tracking of clinical information for individual and general patient populations to guide treatment and effectively anticipate community health care problems.

"Community-based health care clinic." A nonprofit health care center located in this Commonwealth that provides comprehensive health care services without regard for a patient's ability to pay and that:

(1) meets either of the following criteria:

(i) serves a federally designated medically underserved area, a medically underserved population or a health professional shortage area; or

(ii) serves a patient population with a majority of that population having an income less than 200% of the Federal poverty income guidelines; and

(2) includes any of the following:

(i) A federally qualified health center as defined in section 1905(l)(2)(B) of the Social Security Act (49 Stat. 620, 42 U.S.C.§ 1396d(l)(2)(B)) or a federally qualified health center look-alike and is a participating provider with:

(A) the Department of Public Welfare under the act of June 13, 1967 (P.L. 31, No. 21), known as the Public Welfare Code; or

(B) the Children's Health Insurance Program under:

(I) Title XXI of the Social Security Act (49 Stat. 620, 42 U.S.C.§ 1397aa et seq.); and

(II) Article XXIII of the act of May 17, 1921 (P.L. 682, No. 284), known as The Insurance Company Law of 1921, and the regulations promulgated thereunder.

(ii) A rural health clinic as defined in section 1861(aa)(2) of the Social Security Act (49 Stat. 620, 42 U.S.C.§ 1395x(aa)(2)), certified by Medicare and is a participating provider with:

(A) the Department of Public Welfare under the Public Welfare Code; or (B) the Children's Health Insurance Program under:

(I) Title XXI of the Social Security Act; and

(II) Article XXIII of The Insurance Company Law of 1921 and the regulations promulgated thereunder.

(iii) A hospital health clinic and is a participating provider with:

(A) the Department of Public Welfare under the Public Welfare Code; or

(B) the Children's Health Insurance Program under:

(I) Title XXI of the Social Security Act; and

(II) Article XXIII of The Insurance Company Law of 1921 and the regulations promulgated thereunder.

(iv) A free or partial-pay health clinic that provides services by volunteer and nonvolunteer health care providers.

(v) A nurse-managed health care clinic that is managed by a certified clinical nurse specialist, a certified registered nurse anesthetist, a certified registered nurse practitioner or a certified nurse midwife, is associated with a nursing education program, a federally qualified health center or an independent nonprofit health or social services agency and is a participating provider with:

(A) the Department of Public Welfare under the Public Welfare Code; or

(B) the Children's Health Insurance Program under:

(I) Title XXI of the Social Security Act; and

(II) Article XXIII of The Insurance Company Law of 1921 and the regulations promulgated thereunder.

"Department." The Department of Health of the Commonwealth.

"Health care provider." A health care provider licensed to practice a component of the healing arts by a licensing board within the Department of State who provides health care services at a community-based health care clinic.

"Hospital." An entity located in this Commonwealth that is licensed as a hospital under the act of July 19, 1979 (P.L. 130, No. 48), known as the Health Care Facilities Act.

"Low-income patient." A patient whose household income is below 200% of the Federal poverty income guidelines.

"Medical assistance." A State program of medical assistance established under Article IV(f) of the act of June 13, 1967 (P.L. 31, No. 21), known as the Public Welfare Code.

"Patient." A natural person receiving health care from a health care provider at a community-based health care clinic.

"Program." The Community-Based Health Care Program.

35 P.S. § 10227.102

Added by P.L. 32 2013 No. 10, § 1, eff. 8/19/2013.