Definitions

The following terms used in 130 CMR 405.000 have the meanings given in 130 CMR 405.402 unless the context clearly requires a different meaning. The reimbursability of services defined in 130 CMR 405.000 is not determined by these definitions, but by application of 130 CMR 405.000 and 450.000: Administrative and Billing Regulations. 340B Covered Entities. Facilities and programs eligible to purchase discounted drugs through a program established by Section 340B of Public Law 102-585, the Veterans Health Care Act of 1992. 340B Drug Pricing Program. A program established by Section 340B of Public Law 102-585, the Veterans Health Care Act of 1992. Acupuncture. The insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, with or without the application of an electric current, and with or without the application of heat to the needles, skin, or both. Family Practitioner. A licensed physician who is board-eligible or board-certified in family practice. A family practitioner provides continuous, accessible medical care with emphasis on the family unit that combines appreciation of both the biomedical and psychosocial dimensions of illness. The family practitioner assumes responsibility for and provides most of the member’s health care, and coordinates the member’s total health needs. Family Therapy. A session for simultaneous treatment of two or more members of a family. Freestanding Clinic. Any institution licensed as a clinic by the Massachusetts Department of Public Health pursuant to M.G.L. c. 111, § 51 that is not part of a hospital and that possesses its own legal identity, maintains its own patient records, and administers its own budget and personnel. Such institutions include CHCs and mental health centers. Group Clinic Visit. A session conducted by a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, or registered nurse to introduce preventive medicine approaches to personal health and safety and to present self-help and personal management information concerning family medicine, adult medicine, sex education, and chronic illness. Tobacco cessation group clinic visits may be provided by MassHealth-qualified tobacco cessation counseling providers as defined in 130 CMR 405.472. Group Therapy. Application of psychotherapeutic or counseling techniques to a group of persons, most of whom are not related by blood, marriage, or legal guardianship. Health Practitioner. An individual who can diagnose and treat medical problems whether by authority of their own license or by the delegated authority of a licensed medical professional. HIV Post-test Counseling Visit. A face-to-face meeting at the CHC between the member and a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, registered nurse, or counselor (working under the supervision of one of the aforementioned) for the purpose of providing counseling after HIV testing. Such counseling will include information about the implications of positive and negative test results, risk-reduction techniques, partner notification, and referral to medical and support services, in accordance with established protocols of the Massachusetts Department of Public Health. HIV Pre-test Counseling Visit. A face-to-face meeting at the CHC between the member and a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, registered nurse, or counselor (working under the supervision of one of the aforementioned) for the purpose of providing counseling before HIV testing. Providers will offer information on risk factors and implications of both positive and negative test results, in accordance with established protocols of the Massachusetts Department of Public Health. Home Visit. A face-to-face meeting between a member and a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, or registered nurse in the member's residence for examination, diagnosis, or treatment. Hospital Visit. A face-to-face meeting between a member and a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, or registered nurse when the member has been admitted to a hospital by a physician on the CHC's staff. Individual Medical Visit. A face-to-face meeting at the CHC between a member and a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, or registered nurse for medical examination, diagnosis, or treatment. Individual Mental Health Visit. A face-to-face meeting at the CHC between a patient and either a psychiatrist or an advanced practice registered nurse (APRN) with a graduate degree and advanced training in psychiatric care (a psychiatric clinical nurse specialist or a psychiatric mental health nurse practitioner) within the community health center setting, for purposes of examination, diagnosis, or treatment. Individual Therapy. Psychotherapeutic services provided to an individual. Institutionalized Individual. For purposes of 130 CMR 405.428 through 405.430, an individual who is (1) involuntarily confined or detained, under a civil or criminal statute in a correctional or rehabilitative facility, including a psychiatric hospital or other facility for the care and treatment of mental illness; or (2) confined, under a voluntary commitment, in a psychiatric hospital or other facility for the care and treatment of mental illness. Mentally Incompetent Individual. For purposes of 130 CMR 405.428 through 405.430, an individual who has been declared mentally incompetent by a federal, state, or local court of competent jurisdiction for any purpose, unless the individual has been declared competent for purposes that include the ability to consent to sterilization. Nursing Facility Visit. A visit by a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, or registered nurse to a member who has been admitted to a nursing facility, extended care facility, or convalescent or rest home. Primary or Elective Care. Medical care required by individuals or families that is appropriate for the maintenance of health and the prevention of illness. This care includes, but is not limited to, physical examination, diagnosis and management of illness, ongoing health maintenance, accident prevention, and referral when necessary. This care does not require the specialized resources of a hospital emergency department. Psychological Testing. The use of standardized test instruments to evaluate aspects of an individual's functioning, including aptitudes, educational achievements, cognitive processes, emotional conflicts, and type and degree of psychopathology. Sterilization. Any medical procedure, treatment, or operation for the purpose of rendering an individual permanently incapable of reproducing. Urgent Care. Medical services required promptly to prevent impairment of health due to symptoms that a prudent layperson would believe require medical attention, but are not life-threatening and do not pose a high risk of permanent damage to an individual’s health. Urgent care does not include elective or primary care.