Tenn. Comp. R. & Regs. 1200-20-03-.02 - DEFINITIONS

The following definitions shall apply to terms as they appear in these rules of the Department of Health, unless the context clearly requires otherwise.

(1) Approved Training Program - An Accreditation Council on Graduate Medical Education (A.C.G.M.E.)-approved post-medical school graduate study, completion of which allows a practitioner to be board-eligible and is a prerequisite for Board certification of physicians in family medicine, pediatrics, internal medicine, preventive medicine, and/or obstetrics and gynecology by the American Board of Family Practice, the American Board of Pediatrics, the American Board of Internal Medicine, the American Board of Preventive Medicine, or the American Board of Obstetrics and Gynecology, respectively; or, an American Osteopathic Association approved post-medical school graduate study, completion of which allows a practitioner to be board-eligible and is a prerequisite for certification of physicians in family medicine, pediatrics, internal medicine, and/or obstetrics and gynecology by the American Osteopathic Board of General Practice, the American Osteopathic Board of Pediatrics, the American Osteopathic Board of Internal Medicine, or the American Osteopathic Board of Obstetrics and Gynecology, respectively; or, a regionally accredited master's level education program that leads to certification eligibility in Tennessee as a nurse practitioner or a nurse practitioner with a specialty in midwifery; or, a nationally accredited bachelor's or master's level educational program that leads to licensure in Tennessee as a physician assistant; or, graduation from an approved United States School of Dentistry accredited by the American Dental Association.

All physicians must be either Board-eligible or Board-certified to qualify for the Health Access Program.

(2) Area-Metropolitan - Any area within the boundaries of Davidson, Hamilton, Knox, and Shelby counties of the State of Tennessee.
(3) Area-Rural - An area that is not an area-metropolitan.
(4) Commissioner - The Commissioner of the Tennessee Department of Health or his/her designee.
(5) Community - A society or body of people living in the same place, under the same laws and regulations, who have common rights, privileges, or interests.
(6) Contract - An agreement between a health care practitioner or a non-physician health care practitioner and the State of Tennessee consisting of a promise or mutual promises which the law will enforce.
(7) Contract Start Date - The official start date reflected in the contract agreement between the Department of Health and the Health Access Incentive Grant recipient. A practitioner may begin practice in a HRSA prior to the contract start date as long as the application was made prior to the initiation of practice. The practitioner's contract start date cannot begin until the practitioner has submitted proof of full credentials to the Tennessee Department of Health.
(8) Dental Care Practitioner (DCP) - This category consists of Tennessee licensed dentists. A dentist is anyone who practices general dentistry (as it is defined below).
(9) Department (TDH) - The Tennessee Department of Health.
(10) General Dentistry - The practice of dentistry and dental hygiene. Any person is deemed to be practicing dentistry who diagnoses, prescribes for or treats any disease, pain, deformity, deficiency, injury or physical condition of the human teeth or jaws, or associated structures.
(11) Health Access Incentive Account - A special account within the State treasury established pursuant to the provisions of the Health Access Act of 1989, now found at T.C.A. Section 66-29-151. Amounts in the account are to be used to encourage location of appropriate practitioners of health or dental care or the expansion of health or dental care services in HRSA's through programs developed by the Commissioner.
(12) Health Care Practitioner (HCP) - This category consists of Tennessee licensed physicians with a specialty in family practice, general internal medicine, pediatrics, preventive medicine, obstetrics or obstetrics/gynecology.
(13) Health Care Provider (HCPRO) - This category consists of health care practitioners (HCP's) and non-physician health care practitioners (NPHCP's).
(14) Health Professional Shortage Area (HPSA) - A geographical area which is designated by the Secretary of the U.S. Department of Health and Human Services as having a shortage of health professionals (formerly Health Manpower Shortage Area).
(15) Health Resource Shortage Area (HRSA) - An area designated by the Commissioner with inadequate resources in place to ensure access to primary, pediatric or obstetrical medical care, dental care or TennCare services. It includes federally designated HPSA's for the four metropolitan areas and State-designated Health Resource Shortage Areas for Primary Care, Obstetrics, Pediatrics, Dental Care, as well as TennCare.
(16) Health Resource Shortage Area for Dental Care - An area in the state of Tennessee designated by the Commissioner as having a shortage of DCP's.
(17) Health Resource Shortage Area for Obstetrics - An area in the state of Tennessee designated by the Commissioner as having a shortage of HCPRO's who provide obstetrical care.
(18) Health Resource Shortage Area for Pediatrics - An area in the state of Tennessee designated by the Commissioner as having a shortage of pediatric practitioners.
(19) Health Resource Shortage Area for Primary Care - An area in the state of Tennessee designated by the Commissioner as having a shortage of HCPRO's who provide primary care.
(20) Health Resource Shortage Area for TennCare - An area in the state of Tennessee designated by the Commissioner as having a shortage of HCPRO's who provide TennCare services.
(21) J-1 Physician - A foreign medical graduate who was admitted to the United States on a J-1 visa, or who acquired such status after admission to the United States, and who is required to return to the country of his or her nationality or last residence upon the completion of their participation in an exchange visitor program.
(22) Locum Tenens - A health care practitioner who temporarily takes the place of another health care practitioner by agreement with the Department and who is licensed to practice in Tennessee. Locum tenens is available to Health Access Incentive Grant recipients currently on contract with the Department of Health.
(23) Managed Care Organization (MCO) - An entity rendering or arranging necessary medical services to persons who are or would have been eligible under the Medicaid program as it was administered during state fiscal year 1992-93 and non-Medicaid eligible Tennesseans who are uninsured or who are uninsurable and who are enrolled in the TennCare managed care program. MCO's are pre-paid by the State of Tennessee a monthly capitation payment authorized and consistent with a Section 1115 waiver of the Social Security Act granted by the Health Care Financing Administration, U.S. Department of Health and Human Services.
(24) Medical Recruitment Fair - A combined effort between the Department of Health and local communities to help place primary care physicians, dentists, nurse practitioners, nurse midwives, and physician assistants in areas of Tennessee with inadequate access to primary medical or dental care. The recruitment fair offers an opportunity for providers to meet with representatives of Tennessee's underserved communities to discuss present and future practice opportunities.
(25) National Health Service Corps (NHSC) - A program which places U.S. Public Health Service personnel in areas with a critical shortage of health professionals for the purpose of improving the delivery of health care and services to persons residing in such areas.
(26) Non-Physician Health Care Practitioner (NPHCP) - A certified nurse practitioner, or a licensed physician assistant, or a certified nurse practitioner with a specialty in midwifery providing primary care to the general population.
(27) Office of Health Access - The office within the Tennessee Department of Health's Bureau of Health Services officially designated to administer the Health Access Incentive Grant Program.
(28) Permanent Resident - A person who has been lawfully admitted to reside in the United States for an indefinite period of time. Permanent residents are issued a green card, but they are not U. S. citizens. Permanent residents may apply for U.S. citizenship:
(a) once they have had a green card for five (5) years; or
(b) once they have had a green card for three (3) years and are married to a U. S. citizen.
(29) Population - The number of persons residing in an area according to the most recent census in the most current issue of "Current Population Reports" as determined and published by the U.S. Department of Commerce, Bureau of Census.
(30) Population to Provider Ratio - The ratio derived by dividing the population of the area by the number of HCPRO's providing primary care services in the area. The full-time equivalent will be calculated by including HCPRO's, regardless of their age, working part-time, as well as full-time hours. Also included will be J-1 HCP's and HCPRO's placed by the National Health Service Corps. Interns, residents, and faculty are excluded.
(31) Practice Start Date - The agreed upon date that a HCPRO commences practice in a designated HRSA.
(32) Practice Visits - The total number of Medicare, TennCare, private pay patients, and all other patient visits seen by the provider during any calendar month.
(33) Precepting Physician - A Tennessee licensed physician whose practice incorporates a non-physician health care practitioner. The precepting physician supervises and directs the delivery of delegated medical services by the non-physician health care practitioner. The services may be delegated by a written protocol format.
(34) Primary Care - Basic entry level of health care rendered by HCPRO's, usually in an outpatient setting. This type of service delivery emphasizes caring for the patient's general health needs as opposed to a more specialized approach to medical care.
(35) Private Pay - A person who is not covered by either public, private or employer-provided comprehensive health insurance.
(36) Protocol - Written guidelines for medical management of patients that are sufficient in detail to include the scope of delegated medical management duties. It is jointly prepared and accepted by a physician and a non-physician health care practitioner consistent with State law.
(37) Rational Service Area - Rational Service Areas are individual counties (or groups of counties) or communities that have displayed certain obvious primary care, pediatric or obstetrical care service patterns for residents of that county or community and/or surrounding areas. Determining factors for delineating rational service areas include, but are not limited to, natural or artificial barriers (mountains, bad roads), geographic patterns of care, the presence or absence of health professionals or facilities, and patients' payment capabilities.
(38) Regional Health Office (RHO) - One of a number of single or multiple-county offices, each headed by a director, which is designated by the Department to oversee provision of public health services in a well-defined geographic area.
(39) Solo Practice - Delivery of medical services where a physician practices without another physician and where back-up coverage is not available.
(40) TennCare - A comprehensive managed care program for reforming the delivery of health care services in Tennessee. TennCare was granted as a research and demonstration waiver by the Health Care Financing Administration U. S. Department of Health and Human Services, under Section 1115 of the Social Security Act, and was designed to provide quality health care services to Tennessee's low-income, uninsurable, and uninsured populations.
(41) TennCare Population to TennCare Provider Ratio - The ratio derived by dividing the TennCare population of the area by the number of HCPRO's providing TennCare services in the area. The full-time equivalent will be calculated by including HCPRO's, regardless of their age, working part-time, as well as full-time hours. Also included will be J-1 HCP's and HCPRO's placed by the National Health Service Corps. Interns, residents, and faculty are excluded.

Notes

Tenn. Comp. R. & Regs. 1200-20-03-.02
Original rule filed October 24, 1990; effective December 12, 1990. Amendment filed December 3, 1991; effective January 17, 1992. Repeal and new rule filed April 19, 1994; effective July 3, 1994. Repeal and new rule filed April 19, 2000; effective July 3, 2000.

Authority: T.C.A. Sections 4-5-202, 66-29-151, 68-1-102(b), and 68-1-103.

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