Definitions.

As used in sections 17b-262-337 through 17b-262-349, inclusive, of the Regulations of Connecticut State Agencies: (1) "Acute" means symptoms that are severe and have rapid onset and a short course; (2) "Admission" means the formal acceptance by a hospital of a client who is to receive health care services while lodged in an area of the hospital reserved for continuous nursing services; (3) "Allied Health Professional" or "AHP" means a licensed individual who is qualified by special training, education, skills, and experience in health care and treatment and shall include: psychologists, social workers, nurses, nurse midwives, physician assistants, professional counselors, marital and family therapists, alcohol and drug counselors, physical therapists, occupational therapists, speech therapists, audiologists and respiratory care practitioners as defined in title 20 of the Connecticut General Statutes; (4) "Border provider" means a provider located in a state bordering Connecticut, in an area that allows it to generally serve Connecticut residents, and that is enrolled as and treated as a Connecticut Medical Assistance Program provider. Such providers are certified, accredited, or licensed by the applicable agency in their state and are deemed border providers by the department on a case-by-case basis; (5) "Child" means a person who is under twenty-one years of age; (6) "Chronic disease hospital" means "chronic disease hospital" as defined in section 19-13-D1 of the Regulations of Connecticut State Agencies; (7) "Client" means a person eligible for goods or services under the department's Medicaid program; (8) "Commissioner" means the Commissioner of Social Services appointed pursuant to subsection (a) of section 17b-1 of the Connecticut General Statutes; (9) "Consultation" means those services rendered by a physician whose opinion or advice is requested by the client's physician or agency in the evaluation or treatment of the client's illness; (10) "Department" means the Department of Social Services or its agent; (11) "Early and Periodic Screening, Diagnostic and Treatment services" means the services provided in accordance with section 1905(r) of the Social Security Act, as amended from time to time; (12) "Emergency" means a medical condition, including labor and delivery, 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 placing the client's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part; (13) "Family planning services" means any medically approved diagnostic procedure, treatment, counseling, drug, supply, or device which is prescribed or furnished by a provider to individuals of childbearing age for the purpose of enabling such individuals to freely plan the number and spacing of their children; (14) "Fees" means the payments for services, treatments, and drugs administered by physicians which shall be established by the commissioner and contained in the department's fee schedules; (15) "General hospital" means "general hospital" as defined in section 17-134d-80 of the Regulations of Connecticut State Agencies; (16) "Home" means the client's place of residence, which includes a boarding home, community living arrangement, or residential care home. Home does not include facilities such as hospitals, chronic disease hospitals, nursing facilities, intermediate care facilities for the mentally retarded (ICF/MR), or other facilities that are paid an all inclusive rate directly by Medicaid for the care of the client; (17) "Hysterectomy "means "hysterectomy" as defined in 42 CFR 441.251; (18) "Informed consent" means "informed consent" as defined in 42 CFR 441.257; (19) "Intermediate care facility for the mentally retarded" or "ICF/MR" means a residential facility for persons with mental retardation licensed pursuant to section 17a-227 of the Connecticut General Statutes and certified to participate in the Medicaid program as an intermediate care facility for the mentally retarded; (20) "Institutionalized individual" means an "institutionalized individual" as defined in 42 CFR 441.251; (21) "Legend Device" means "legend device" as defined in section 20-571 of the Connecticut General Statutes; (22) "Legend Drug" means "legend drug" as defined in section 20-571 of the Connecticut General Statutes; (23) "Medical appropriateness" or "Medically appropriate" means health care that is provided in a timely manner and meets professionally recognized standards of acceptable medical care; is delivered in the appropriate setting; and is the least costly of multiple, equally-effective alternative treatments or diagnostic modalities; (24) "Medicaid" means the program operated by the Department of Social Services pursuant to section 17b-260 of the Connecticut General Statutes and authorized by Title XIX of the Social Security Act; (25) "Medical necessity" or "medically necessary" means health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or to prevent a medical condition from occurring; (26) "Medical record" means "medical record" as defined in section 19a-14-40 of the Regulations of Connecticut State Agencies; (27) "Mentally incompetent individual" means a "mentally incompetent individual" as defined in 42 CFR 441.251; (28) "Nursing facility" means a "nursing facility" as defined in 42 USC 1396r(a); (29) "Out of state provider" means a provider that is located outside Connecticut and is not a border provider; (30) "Panel or Profile Tests" means certain multiple tests performed on a single specimen or material derived from the human body which are related to a condition, disorder or family of disorders, which when combined mathematically or otherwise, comprise a finished identifiable laboratory study or studies; (31) "Physician" means a person licensed pursuant to section 20-10 of the Connecticut General Statutes; (32) "Physicians' services" means services provided: (A) by a physician within the scope of practice as defined by state law; or (B) by an AHP within the scope of practice of the AHP as defined by state law; (33) "Prior authorization" means approval for the provision of a service or the delivery of goods from the department before the provider actually provides the service or delivers the goods; (34) "Provider" means a licensed physician or physician group enrolled in the Medicaid program, or an AHP acting within their scope of practice; (35) "Quality of care" means the evaluation of medical care to determine if it meets the professionally recognized standards of acceptable medical care for the condition and the client under treatment; (36) "Sterilization" means "sterilization" as defined in 42 CFR 441.251; (37) "Under the supervision" means that the physician shall assume professional responsibility for the service performed by the AHP; (38) "Usual and customary charge" means the amount that the provider charges for the service or procedure in the majority of non-Medicaid cases. If the provider varies the charges so that no one amount is charged in the majority of cases, "usual and customary charge" shall be defined as the median charge. Token charges for charity patients and other exceptional charges are to be excluded; and (39) "Utilization review" means "utilization review" as defined in section 17-134d-80 of the Regulations of Connecticut State Agencies.