Idaho Admin. Code r. 16.03.09.012 - DEFINITIONS: P THROUGH Z
01.
Participant . A person eligible for and enrolled in the Idaho Medical
Assistance Program. (3-17-22)
02.
Patient . The person undergoing treatment or receiving services
from a provider . (3-17-22)
03.
Pharmacist . A person who meets all the applicable requirements to
practice as a licensed pharmacist according to state regulations where the
services are provided. (7-1-23)T
04.
Physician . A person
possessing a Doctor of Medicine (MD) degree or a Doctor of Osteopathy (DO)
degree, and within the State or United States territory services are provided
is either licensed to practice medicine, is a resident enrolled in a
postgraduate medical training program, is a licensed international medical
graduate, or is a licensed bridge year physician . (7-1-23)T
05.
Physician Assistant (PA). A
person who meets all the applicable requirements to practice as a licensed PA
according to state regulations where the services are provided.
(7-1-23)T
06.
Plan of
Care. A written description of medical, remedial, habilitative, or
rehabilitative services to be provided to a participant , developed by or under
the direction and written approval of a physician. Medications, services, and
treatments are identified specifically as to amount, type, and duration of
service. (7-1-23)T
07.
Prepaid Ambulatory Health Plan (PAHP) . Under
42 CFR
438.2, an entity that provides medical
services to enrollees under contract with the Department on the basis of
prepaid capitation payments, or other arrangements that do not use State Plan
payment rates. The PAHP does not provide or arrange for, and is not responsible
for the provision of any inpatient hospital or institutional services for its
enrollees, and does not have a comprehensive risk contract. (7-1-23)T
08.
Private Rate . Rate most
frequently charged to private patients for a service or item.
(3-17-22)
09.
Prosthetic
Device. Replacement, corrective, or supportive devices prescribed by a
physician or other licensed practitioner of the healing arts profession within
the scope of their practice as defined by state law to: (3-17-22)
a. Artificially replace a missing portion of
the body; or (3-17-22)
b. Prevent
or correct physical deformities or malfunctions; or (3-17-22)
c. Support a weak or deformed portion of the
body. (3-17-22)
d. Computerized
communication devices are not included in this definition of a prosthetic
device. (3-17-22)
10.
Provider . Any individual, partnership, association, corporation,
or organization, public or private, that furnishes medical goods or services in
compliance with these rules and who has applied for and received a Medicaid
provider number and who has entered into a written provider agreement with the
Department under Section
205 of these rules.
(7-1-23)T
11.
Provider
Agreement. A written agreement between the provider and the Department ,
entered into under Section
205 of these rules.
(7-1-23)T
12.
Provider
Reimbursement Manual (PRM). A federal publication that specifies
accounting treatments and standards for the Medicare program, CMS Publications
15-1 and
15-2, that are incorporated in
Section 004 of these
rules. (7-1-23)T
13.
Psychologist, Licensed . A person licensed to practice psychology
according to state regulations where the services are provided.
(7-1-23)T
14.
Psychologist
Extender. A person who practices psychology under the supervision of a
licensed psychologist who meets state regulations where the services are
provided. (7-1-23)T
15.
Public Provider . A public provider is one operated by a federal,
state, county, city, or other local government agency or instrumentality.
(3-17-22)
16.
Qualified
Interpreter. A person who meets the definition of qualified interpreter
under 28 CFR
35.104. (7-1-23)T
17.
Quality Improvement Organization
(QIO). An organization that performs utilization and quality control
review of health care furnished to Medicare and Medicaid participants. A QIO is
formerly known as a Peer Review Organization (PRO). (3-17-22)
18.
Related Entity . An
organization with which the provider is associated or affiliated to a
significant extent, or has control of, or is controlled by, that furnishes the
services, facilities, or supplies for the provider . (3-17-22)
19.
Registered Nurse (RN) . A
person who meets all the applicable requirements and is licensed to practice as
an RN according to state regulations where the services are provided.
(7-1-23)T
20.
Rural Health
Clinic (RHC). An outpatient entity that meets the requirements of
42 USC Section
1395x(aa)(2). It is
primarily engaged in furnishing physicians and other medical and health
services in rural, federally defined, medically underserved areas, or
designated health professional shortage areas. (7-1-23)T
21.
Rural Hospital -Based Nursing
Facilities. Hospital -based nursing facilities not located within a
metropolitan statistical area (MSA) as defined by the United States Bureau of
Census. (3-17-22)
22.
Social
Security Act. 42 USC
101 et seq., authorizing, in part, federal
grants to the states for medical assistance to low-income persons who meet
certain criteria. (3-17-22)
23.
State Plan . The contract between the state and federal government
under 42 USC Section
1396a(a).
(3-17-22)
24.
Supervision . Procedural guidance by a qualified person and initial
direction and periodic inspection of the actual act, at the site of service
delivery. (3-17-22)
25.
Title
XVIII. Title XVIII of the Social Security Act , known as Medicare, for
aged, blind, and disabled individuals administered by the federal government.
(3-17-22)
26.
Title
XIX. Title XIX of the Social Security Act , known as Medicaid , is a
medical benefits program jointly financed by the federal and state governments
and administered by the states. This program pays for medical assistance for
certain individuals and families with low income and limited resources.
(3-17-22)
27.
Title
XXI. Title XXI of the Social Security Act , known as the State Children's
Health Insurance Program (SCHIP). This is a program that primarily pays for
medical assistance for low-income children. (3-17-22)
28.
Third Party . Includes a
person, institution, corporation, or public or private agency that is liable to
pay all or part of the medical cost of injury, disease, or disability of a
medical assistance participant. (7-1-23)T
29.
Transportation . The physical
movement of a participant to and from a medical appointment or service by the
participant , another person, taxi, or common carrier. (7-1-23)T
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.