R590-237-4. Definitions

In addition to the definitions in Sections 31A-1-301 and 31A-8-101, the following definitions apply to this rule:

(1) "Board of Directors," for the purpose of this rule, means the local board of directors for the independent hospital that is directly responsible for the daily policy and financial decisions. board of directors does not include a corporate board of directors for the entity that owns the independent hospital.

(2) "Credentialed staff member" means a health care provider with active staff privileges at an independent hospital or a federally qualified health center. A credentialed staff member is not required to be an employee of the independent hospital or federally qualified health center.

(3) "Federally Qualified Health Center," as defined in the Social Security Act 42 U.S.C., Sec. 1395x, means an entity which:

(a)(i) is receiving a grant under Section 330, other than Subsection (h) of the Public Health Service Act 42 U.S.C, 254b; or

(ii)(A) is receiving funding from a grant under a contract with the recipient of such a grant; and

(B) meets the requirements to receive a grant under Section 330, other than Subsection (h) of the Public Health Service Act 42 U.S.C. 254b;

(b) based on the recommendation of the Health Resources and Services Administration within the Public Health Service is determined by the Secretary of Health and Human Services to meet the requirements for receiving such a grant;

(c) was treated by the Secretary of Health and Human Services as a comprehensive Federally funded health center as of January 1, 1990; or

(d) is an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act, 25 U.S.C. 450f, or by an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act, 25 U.S.C. 1651.

(4) "Local practice location" means the provider's office where services are rendered which is:

(a) permanently located within a county with a population density of less than 100 people per square mile; and

(b) is within 30 miles of paved roads of:

(i) the place where the enrollee lives or resides; or

(ii) the location of the independent hospital or federally qualified health center at which the enrollee may receive covered benefits pursuant to Subsection 31A-8-501(2) or (3).

(5) "Policy and financial decisions" means the day-to-day decisions made by the local Board of directors with regard to hospital policy and financial solvency.

(6) "Provider" means any person who:

(a) furnishes health care directly to the enrollee; and

(b) is licensed or otherwise authorized to furnish the health care in this state.

(7) "Referral" means:

(a) the request by a health care provider for an item, service, test, or procedure to be performed by another health care provider;

(b) the request by a physician for a consultation with another physician; or

(c) the request or establishment of a plan of care by a physician.

(8) "Rural County" means a county as described in Subsection 31A-8-501(2)(b).