Definitions

As used in 105 CMR 173.000, the following definitions shall apply unless the context requires otherwise: 911 EMS Patient. An individual who has activated a Primary Ambulance Response by dialing the emergency telephone access number 911, or its local equivalent. Ambulance Service. An entity licensed by the Department pursuant to 105 CMR 170.000: Emergency Medical Services System to provide emergency medical services. Applicant. A Community EMS Applicant or an MIH Applicant as further defined. Authorization to Practice. The approval granted to EMS Personnel by the medical director of the MIH or Community EMS Program approved by the Department pursuant to 105 CMR 173.000. Certificate of Approval. Written approval to operate an MIH or Community EMS Program pursuant to 105 CMR 173.000, subject to all terms and conditions contained in the Certificate of Approval. Commissioner. The Commissioner of Public Health or his or her designee. Community EMS Applicant. A local public health authority seeking an initial Certificate of Approval or renewal thereof to operate a Community EMS Program in partnership with the local jurisdiction's designated primary ambulance service. 9/7/18 - (corrected in Mass. Register 1375 10/5/18) Community EMS Program. A program operated by the local public health authority and developed in coordination with the local jurisdiction's designated primary ambulance service(s) and which utilizes the primary ambulance service's EMS Personnel to provide community outreach and assistance in order to advance illness or injury prevention within the local jurisdiction(s) in accordance with 105 CMR 173.060. The Community EMS Program shall be approved by the local jurisdiction, in the manner required by such jurisdiction, and the ambulance service's affiliate hospital medical director. Community Paramedic. A person who: is certified as a paramedic pursuant to M.G.L. c 111C and 105 CMR 170.000: Emergency Medical Services System; (2) has successfully completed an education program developed or selected by the medical director of the MIH Program for which the community paramedic is employed, as well as any additional training required by Department guidelines; and (3) is dispatched by an MIH Program to provide services or treatment to a patient within his or her scope of practice in accordance with Department-issued Statewide Treatment Protocols and clinical protocols of the program. Department. The Department of Public Health, pursuant to M.G.L. c. 17, § 1. Duplication of Services. A proposed service which does not address a gap in service delivery, pursuant to 105 CMR 173.040(A). ED Avoidance. A component of an MIH Program pursuant to 173.050 that includes the applicable local jurisdiction(s)'s designated primaryambulance service(s) and, following primary ambulance response, assessment and consultation with on-line medical direction, utilizes paramedics with advanced training to manage the patient as an MIH patient in accordance with the provisions of 105 CMR 173.100(A) and Department guidelines. EmergencyMedical Technician (EMT). An EMT-Basic, Advanced EMTorParamediccertified by the Department pursuant to 105 CMR 170.000: Emergency Medical Services System. EmergencyServiceProgram (ESP). Adesignated program underthedirection oftheDepartment of Mental Health and MassHealth Office of Behavioral Health that provides behavioral health crisis assessment, intervention and stabilization services through four service components: (1) Mobile Crisis Intervention (MCI) services for youth; (2) adult mobile services; (3) ESP community based locations; (4) and community crisis stabilization (CCS) services for 18 years of age and older. EMS. Emergency medical services, as defined in 105 CMR 170.000: Emergency Medical Services System. EMS First Responder (EFR). A person certified pursuant to 105 CMR 170.000: Emergency Medical Services System who has, at a minimum, successfully completed a course in emergency medical care approved by the Department pursuant to M.G.L. c. 111, § 201 and 105 CMR 171.000: Massachusetts First Responder Training and who provides emergency medical care through employment by, or in association with, a licensed EFR service at the first responder level. EMS First Response Service (EFR Service). An entity licensed by the Department pursuant to 105 CMR 170.000: Emergency Medical Services System to provide rapid response and EMS. EMS Personnel. EFRs and EMTs. Entity or Person. An individual or his or her estate upon his or her death, or a corporation, a government agency, a partnership, a trust, an association, or an organized group of persons, whether incorporated or not, or any receiver, trustee, or other liquidating agent of any of the foregoing while acting in such capacity. Health Care Entity. A health care facility, health care provider, local public health authority, provider organization, carrier, or any combination thereof, including, but not limited to, an ambulance service licensed under M.G.L. c. 111C, a visiting nurse association, an accountable care organization, or a home health agency. Health Care Facility. A licensed institution providing health care services or a health care setting, including, but not limited to, hospitals and other licensed inpatient centers, ambulatory, surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings. Health Care Personnel or Personnel. An individual or individuals employed by or affiliated with a health care provider, who provide direct patient care. Health Care Personnel may include, but not be limited to, CommunityParamedics, EMS Personnel, EMS First Responders, nurses, Nurse Practitioners, Physician Assistants, or social workers. Health Care Provider. A provider of medical, behavioral or health services or any other person or organization that furnishes bills or is paid for health care services delivery in the normal course of business. Injury. Harm that results in exacerbation, complication or other deterioration of a patient's condition. Local Jurisdiction. A city or town or multiple cities or towns. Local Public Health Authority. The appropriate and legally designated health authority of the city, town, or other legally constituted governmental unit within the Commonwealth having the usual powers and duties of the board of health or health department of a city or town. Medical Control. The clinical oversight provided by a physician or existing primary care provider to all components of the MIH Program, including, but not limited to, medical direction, training, scope of practice and authorization to practice of EMS Personnel, which may include community paramedics, continuous quality assurance and improvement and clinical protocols. Medical Direction. The authorization for treatment provided by a physician or existing primary care provider in accordance with clinical protocols, whether on-line through direct communication or telecommunication, or off-line through standing orders. Medical Director. The physician or physicians appropriately trained to meet the unique social/cultural, linguistic, medical and population health needs of an MIH Program's patient population and designated by the MIH Program to carry out any supervisory medical control responsibilities for the MIH Program. MIH Applicant. A health care entity or entities seeking an initial Certificate of Approval or renewal thereof to operate an MIH Program. MIH Patient. An individual identified by a health care entity as warranting MIH Program services. Mobile Integrated Health Care Program (MIH Program). A Department-approved program, including MIH Programs with an ED Avoidance Component, that utilizes EMS Personnel, which may include community paramedics to deliver healthcare services to patients in an out-of­ hospital environment in coordination with health care facilities or other health care providers, which may include, but not be limited to, primary care providers, home care agencies, visiting nurse associations, or other in-home services; provided, that the medical care and services may include, but not be limited to, chronic disease management, behavioral health, preventative care, post-discharge follow-up visits, or transport or referral to facilities other than hospital emergency departments. Nurse Practitioner. A licensed registered nurse authorized by the Massachusetts Board of Registration in Nursing to practice in the Commonwealth of Massachusetts as an Advanced Practice Registered Nurse pursuant to 244 CMR 4.00: Advanced Practice Registered Nursing and whose scope of practice includes the provision of primary care services. Physician. A physician duly licensed to practice medicine in the Commonwealth of Massachusetts by the Massachusetts Board of Registration in Medicine, pursuant to M.G.L. c. 112, § 2 and 243 CMR: Board of Registration in Medicine. Physician Assistant. A person who is registered pursuant to 263 CMR: Board of Registration of Physician Assistants and who may provide medical services appropriate to his or her training, experience and skills under the supervision of a registered physician. Primary Ambulance Response. First-line ambulance response, pre-hospital treatment and, if applicable, transportation by an ambulance service designated as a service zone provider or recognized in a service zone plan to provide first-line ambulance response, pre-hospital treatment and transportation pursuant to a provider contract. Primary Ambulance Service. The business or regular activity, whether for profit or not, by an ambulance service licensed pursuant to 105 CMR 170.000: Emergency Medical Services System, designated under a service zone plan for the purpose of providing rapid response and pre-hospital EMS, including, without limitation, patient assessment, patient treatment, patient preparation for transport and patient transport to appropriate health care facilities, in conformance with the service zone plan. PrimaryCareProvider. Aphysician, physician assistant ornursepractitionerqualifiedtoprovide general medical care who: supervises, coordinates, prescribes, or otherwise provides or proposes health care services; (2) initiates referrals for specialist care; and (3) maintains continuity of care within the scope of practice. Provider Organization. Any corporation, partnership, business trust, association or organized group of persons, which is in the business of health care delivery or management, whether incorporated or not, that represents one or more health care providers in contracting with carriers or third-party administrators for the payment of health care services; provided that the definition shall include, but not be limited to, physician organizations, physician-hospital organizations, independent practice associations, provider networks, accountable care organizations, and any other organization that contracts with carriers or third-partyadministrators for payment for health care services. Scope of Practice. The clinical skills or functions that: (1) are defined by applicable state laws and regulations governing certification, licensure or registration of each individual providing services or treatment in the MIH or Community EMS Program approved by the Department pursuant to 105 CMR 173.000; and (2) the clinical protocols developed by such programs. Serious Incident. An incident that results in injury to a patient not ordinarily expected as a result of the patient's condition.