Definitions

Accreditation. Process of evaluation and approval of hospitals conducted by the Joint Commission, the American Osteopathic Association (AOA), or conducted byanother accrediting body approved by the federal Centers for Medicare and Medicaid Services (CMS) and the Commissioner. Acute Stroke Ready Service. The infrastructure and capability by all hospitals with an emergency department and all satellite emergency facilities, to emergently care for patients presenting with symptoms of acute stroke and transfer when clinically appropriate. Ambulatory Care Service. Health care services that do not require overnight hospital stay. Autopsy. A post mortem examination performed by a physician, including the removal and examination of organs, to determine a medical disease, medical condition, or the cause and manner of death, or for other diagnostic, education, quality improvement, or research purposes. Beds Out of Service. Beds not occupied and not qualified for patient occupancy pursuant to the applicable requirements of 105 CMR 130.000. Birth Center. A home-like facility where births expected to be low risk are planned to occur following, uncomplicated pregnancy. Birth Center Services. Professional midwifery services provided to low risk pregnant persons during pregnancy, birth, and post-partum and to the infant during the immediate newborn period by nurse-midwives or by obstetricians or familypractitioners. Birth center services are provided in a free standing facility or in a separate and discrete unit within the hospital. Burn Unit. An intensive care unit for burned inpatients needing care of a more intensive nature than is provided in medical/surgical beds. Burn units are staffed with specially trained physicians, nurses, and support personnel and contain specialized monitoring and therapeutic equipment needed to provide care for severely burned patients. Campus. One of several premises on the license of a hospital that provides health care services. Cardiac Catheterization Services. Diagnostic and interventional services, other than cardiac surgery, that involve the introduction of physical objects (such as catheters) into the heart, its chambers, the pericardium, or the great vessels proximal to the heart. Cardiac Surgery. Surgery on the heart and the thoracic great vessels. Most cardiac surgery requires the use of a heart-lung machine. Those procedures previously requiring the heart-lung machine but now sometimes performed “off-pump” (e.g. coronary artery bypass) are still considered as cardiac surgery. Examples of cardiac surgery include coronary artery bypass grafts, heart valve repair or replacement, heart transplantation, surgery of the thoracic aorta, repair of congenital heart defects and minimally invasive heart surgery. Center for Health Information and Analysis or CHIA. The entity established pursuant to M.G.L. c. 12C. Chronic Care Service. A service, other than a rehabilitation, psychiatric, substance use disorder, intermediate care facility, or skilled nursing facility service, that has an average length of inpatient staygreater than 25 days and that meets the long-term care hospital patient level criteria issued by the Federal Centers for Medicare and Medicaid Services. Commissioner. The Commissioner of the Massachusetts Department of Public Health or his or her designee. CoronaryCare Unit. An intensive care unit staffed with speciallytrained nursing and supportive personnel and equipped with necessary diagnostic, monitoring, and therapeutic equipment needed to provide specialized medical and nursing care to inpatients who, because of heart seizure, open heart surgery, or conditions threatening to the heart, require intensified, comprehensive observation and care. Critical Care Beds. Beds licensed as intensive care, coronary care, pediatric intensive care, neonatal intensive care and (intensive) burn unit service beds. Data Analysis Center (DAC). The organization contracted by the Department to receive, process, analyze and report on the patient-specific cardiac surgery and Percutaneous Coronary Interventions (PCI) outcome data submitted by the acute care hospital. Decedent. A deceased individual or fetus, including a stillborn infant. Deemed Status. That standing granted to an accredited hospital by the Commissioner under 105 CMR 130.000, which exempts the hospital from inspection for compliance with most Medicare Conditions of Participation. Department. The Massachusetts Department of Public Health. Designated Trauma Center. A hospital that has been verified by the American College of Surgeons as a level 1, 2 or 3 adult trauma center, or a level 1 or 2 pediatric trauma center and meets applicable Department standards for designation, or a hospital that has applied for and is in the process of verification as specified in 105 CMR 130.851 and meets applicable Department standards for designation. Dialysis Service. Chronic or acute service, provided in a discrete unit or facility, for treatment of patients with kidney failure. This service includes hemodialysis, peritoneal dialysis or both and related specialized staff and support services. Emergency Service. A service maintained primarily to provide care to outpatients who are in need of immediate medical care to prevent loss of life or aggravation of physiological or psychological illness or injury. Electrophysiology Service. The study of the electrical conduction activity of the heart and characterization of atrial and ventricular arrhythmias obtained by means of a cardiac catheterization procedure. Endovascular Capable Stroke Service. Emergency diagnostic, therapeutic services and endovascular capabilities provided by a multidisciplinary team and available 24 hours per day, seven days per week to patients presenting with symptoms of acute stroke. Essential Health Service. A campus, or any of the services enumerated in the definition of service in 105 CMR 130.020 that is not included in the Excluded Services list. Essential Health Service also includes outpatient dental services, outpatient psychiatric and mental health services, and outpatient reproductive health services: Excluded Services List: (1) Skilled nursing facility service; (2) Intermediate care facility service; (3) Cardiac catheterization service (diagnostic, pediatric, diagnostic and interventional); (4) Chronic care service; (5) Electrophysiology; (6) Hematopoietic Progenitor/Stem Cell Collection, Processing, and Transplant Service; (7) Hematopoietic Progenitor/Stem Cell Transplantation Program or Clinical Trans­ plantation Program; (8) Trauma service as a designated trauma center as defined in 105 CMR 130.851; (9) Medical Control Service. Hospice Service. A coordinated program of home care and inpatient care and services, provided by or arranged to be provided by an interdisciplinary team for persons who are determined to be terminally ill with a limited life expectancy. Inpatient hospital beds used to care for hospice patients shall be licensed as medical/surgical beds. Hospital. Any institution in Massachusetts, however named, whether conducted for charity or for profit, that is advertised, announced, established or maintained for the purpose of caring for persons admitted thereto for diagnosis or medical, surgical or restorative treatment which is rendered within said institution. Hospital shall not include any hospital operated by the Commonwealth of Massachusetts or by the United States. Intensive Care Unit. A unit physically and identifiably separate from general routine (and other) patient care areas, in which are concentrated special equipment and skilled personnel for the care of critically ill inpatients requiring immediate and concentrated continuous care and observation, and which meets the Medicare requirements in 42 CFR 413.53(d) for intensive care type inpatient hospital units. Intermediate Care Facility Service. For services licensed prior to April 21, 1988, a long-term care service that provides routine nursing services and periodic availability of skilled nursing, restorative and other therapeutic services. Intermediate care patients are in a stable condition, needing only supportive nursing care, supervision and observation, and do not require the constant care provided in skilled nursing beds. Licensed Mental Health Professional. A licensed mental health professional shall be a: (1) licensed physician who specializes in the practice of psychiatry; (2) licensed psychologist; (3) licensed independent clinical social worker; (4) licensed certified social worker; (5) licensed mental health counselor; (6) licensed supervised mental health counselor; (7) licensed physician assistant who practices in the field of psychiatry; (8) licensed psychiatric clinical nurse specialist; (9) licensed psychiatric mental health nurse practitioner; (10) healthcare provider qualified within the scope of the individual's license to conduct an evaluation of a mental health condition, including a physician who is in training pursuant to the policies and practices of the hospital; or (11) other licensed master's level mental health clinician, including but not limited to licensed alcohol and drug counselor and licensed marriage and family therapist. Medical/Surgical Service. A general, routine adult acute care service providing medical and/or surgical and nursing care to inpatients on the basis of physicians’ orders and nursing care plans. National Cardiovascular Data Registry (NCDR™). The CathPCI database developed and maintained by the American College of Cardiology. Non English Speaker. A person who cannot speak or understand, or has difficulty speaking or understanding English, because the speaker primarily or only uses a spoken language other than English. Organ. Organs, tissues, and other parts of a human body, including but not limited to eyes, skin, bones, and arteries. Organ shall not mean tissue samples or fluids that are retained to determine the cause and manner of death. Order of Priority. The ranking of an individual who is qualified to provide consent to an autopsy. Pediatric Cardiac Catheterization Services. Providing cardiac catheterization services on an organized, regular basis to infants and children younger than 18 years old. Percutaneous Coronary Interventions (PCI). The procedure for remodeling a blood vessel through the introduction of an expandable balloon catheter. Primary Stroke Service. Emergency diagnostic and therapeutic services provided by a multidisciplinary team and available 24 hours per day, seven days per week to patients presenting with symptoms of acute stroke. Psychiatric Service. A service for inpatients in need of intensive, 24-hour, psychiatric and nursing care and supervision, not including persons hospitalized for substance use disorders. A staff of mental health specialists provides psychiatric, psychological and social evaluation, treatment and aftercare planning. Rehabilitation Service. A service that provides physical restoration and emotional, mental, social and vocational restoration and adjustment for persons with disabilities and meets the inpatient rehabilitation hospital patient and facility criteria issued by the Federal Centers for Medicare and Medicaid Services. The service consists of evaluation, treatment, education, training and placement provided by qualified personnel. A rehabilitation service is directed by a physician experienced and qualified in the field of rehabilitation; and consists of a team effort of the various disciplines of rehabilitation services. The services that shall be provided include at a minimum intensive skilled rehabilitation nursing, physical therapy, occupational therapy, speech therapy, pathology, social services, prosthetic and/or orthotic fitting, and psychological services. Optional services include recreation therapy, dental services, special education, and vocational assessment and counseling. Rural Hospital. An acute care hospital licensed under M.G.L. c. 111, § 51, which: (1) has 50 or fewer licensed beds and based on the published United States Census 2000 data of the US Census Bureau is in a city or town whose population is less than 20,000 and is located within a city, town, service area, or County whose population density is less than or equal to 500 people per square mile and which applies for such a designation; or (2) is a hospital designated as a Critical Access Hospital as of July 1, 2005 by the Federal Department of Health and Human Services in accordance with federal regulations and state requirements. Satellite Emergency Facility (SEF). A health care facility off the premises of a hospital that is listed on the license of the hospital, at which the hospital is authorized pursuant to 105 CMR 130.820 through 130.836 to accept patients transported to the SEF by ambulance, and which operates on a seven day per week 24 hour per day basis. SEFs must comply with all requirements of the federal Emergency Medical Treatment and Active Labor Act (EMTALA). Satellite Unit. An operation off the premises of the hospital at which the hospital provides outpatient health care services. Service. Any of the following specific services, which the Department will list on a hospital’s license if the Department licenses the hospital to deliver the service. Ambulatory Care Services Birth Center Services Burn Unit Cardiac Catheterization Services (diagnostic) Cardiac Catheterization Services (diagnostic and interventional) Cardiac Catheterization Services (pediatric) Cardiac Surgery Chronic Care Service Continuing Care Nursery Service Coronary Care Unit Designated Trauma Center Dialysis Service Electrophysiology Service Emergency Services Endovascular Capable Stroke Services Hematopoietic Progenitor/Stem Cell Collection, Processing and Transplantation Services Hematopoietic Progenitor/Stem Cell Transplantation Program or Clinical Transplantation Program Intensive Care Unit Intermediate Care Facility Service Maternal and Newborn Service Medical Control Service Medical/Surgical Service Neonatal Intensive Care Unit Pediatric Intensive Care Unit Pediatric Service Primary Stroke Service Psychiatric Service Rehabilitation Service Satellite Emergency Facility Skilled Nursing Facility Service Special Care Nursery Service Substance Use Disorder Service Skilled Nursing Facility Service. For services licensed prior to April 21, 1988, a long-term care service that provides continuous skilled nursing care, and restorative and other therapeutic services where beneficial, for patients who have a deteriorating condition requiring skilled care or who show potential for improvement or restoration to a stabilized condition. Patients in skilled nursing care require more intense and continuous skilled nursing care than the supportive nursing care provided in intermediate care beds. Society of Thoracic Surgeons (STS) National Database. The cardiac surgerydatabase developed and maintained by the Society of Thoracic Surgeons (STS). Substance Use Disorder Service. A detoxification and/or rehabilitative treatment service for individuals and their families experiencing the dysfunctional effects of the use of alcohol and/or drugs. Support Service means any of the following: (1) Blood Bank means a facility or support service equipped and staffed to procure, draw, process and/or store and dispense to transfusion services human whole blood and/or its components and/or derivatives. (2) Clinical Laboratory means a facility or place, however named, the purpose of which is to make biological, serological, chemical, immunohematological, cytological, pathological, or other examinations of materials derived from a human body. (3) Transfusion Support Service means a facility or place designed, equipped and staffed to administer human whole blood and/or its components and/or derivatives in transfusion. Trauma. Tissue injury due to the direct effects of externally applied mechanical, thermal, electrical, electromagnetic or nuclear energy, as further defined in the Statewide Treatment Protocols established under 105 CMR 170.000: Emergency Medical Services System. Trauma shall not mean toxic ingestion, poisoning or foreign body ingestion. Transfer of Ownership shall include but not be limited to the following transfers: (1) a transfer of a majority interest in the ownership of a hospital; (2) in the case of a privately-held for-profit corporation, transfer of a majority of any class of the stock thereof; (3) in the case of a partnership, transfer of a majority of the partnership interest; (4) in the case of a trust, change of the trustee or a majority of trustees; or (5) in the case of a non-profit corporation, such changes in the corporate membership and/or trustees as the Department determines to constitute a shift in control of the hospital. A transfer of ownership shall also be deemed to have occurred where foreclosure proceedings have been instituted by a mortgagee in possession. Transfer of Ownership also means any change in the ownership interest or structure of the hospital or the hospital’s organization or parent organization(s) that the commissioner determines to effect a change in control of the operation of the hospital. The commissioner may, in his or her discretion, determine that a proposed transaction does not rise to the level of a transfer of ownership.