Pennsylvania Department of Health

Definitions

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

ABUSE - The willful infliction of injury, unreasonable confinement, intimidation, or punishment that may result in physical harm, pain, or mental anguish to the patient.

ADMINISTRATION - The owner, board of directors, facility director and facility coordinator are responsible for the operation of the facility. They are responsible for managing the facility to ensure the health and safety of the patients.

AMBULATORY SURGICAL FACILITY - A facility or portion thereof not located upon the premises of a hospital which provides specialty or multi-specialty outpatient treatment.

Classification Levels:

Class A - A private or group practice office of practitioners where procedures preformed are limited to those requiring administration of either local or topical anesthesia, or no anesthesia at all.
Class B - A single-specialty or multiple-specialty facility with a distinct part used solely for ambulatory surgical treatments involving administration of sedation analgesia or dissociative drugs. It may be a distinct part of a private or group practice medical or dental office so long as the licensure requirements are met.
Class C - A single-specialty or multiple-specialty facility used exclusively for the purpose of providing ambulatory surgical treatments, which involve the use of a spectrum of anesthetic agents, up to, and including general anesthesia.

BEREAVEMENT COUNSELING - Counseling services provided to the patient's family after the patient's death.

BIRTH CENTER - A facility not part of a hospital which provides maternity care to childbearing families not requiring hospitalization. A birth center provides a home-like atmosphere for maternity care, including prenatal labor delivery and postpartum care related to medically uncomplicated pregnancies.

BIRTH CENTER EMERGENCY TRANSPORTATION - The birth center shall have a written agreement for emergency transportation of the mother or newborn infant which includes the service's emergency medical service certification status and the types of services that are to be provided.

BIRTH CENTER NURSING SERVICES - Nursing services at the birth center shall be under the supervision of the Director of Midwifery Services.

BIRTH CENTER PHYSICIAN DIRECTOR OF MEDICAL AFFAIRS - Insures that the following services are provided: Immediate availability of physician services; an agreement with a Board certified obstetrician and Board certified pediatrician, including arrangements for hospital admission of mother and newborn infant, in order to ensure effective care in life threatening situations.

BIRTH CENTER PHYSICAL ENVIRONMENT - Regulatory requirements involving building safety from fire.

BIRTH CENTER SERVICES AVAILABLE - Obstetric, pediatric, and midwifery services available on a 24-hour basis, 7 days a week, and shall include obstetric and pediatric consultative services, transportation in case of emergency, and provision for referral to outside resources.

BIRTH CENTER SUPPORT PERSON - The individual selected or chosen by a patient to provide emotional support and to assist her during the process of labor and childbirth.

BIRTH CERTIFICATE - A certificate of birth shall be filed for each birth, within 10 days of the birth, with the local registrar of vital statistics, in the district where the birth occurs.

BIRTHING ROOM - A room designed, equipped, and arranged to provide for the care of a woman and newborn, and which includes accommodations for support persons during the process of vaginal childbirth, including the three stages of labor and recovery of a woman and newborn.

CENTER FOR MEDICARE AND MEDICAID SERVICES - The federal agency responsible for the oversight of the Medicare and Medicaid insurance programs.

CERTIFICATION SURVEY- Facilities can voluntarily participate in the Medicare and/or Medicaid Programs. If they choose to participate, the Department conducts an initial certification survey to determine compliance with the federal requirements. Participation in these programs allows Medicare and/or Medicaid recipients to obtain services once the facility has been determined to be a qualified provider.

CHIEF EXECUTIVE OFFICER (CEO) - The facility administrator (of the ESRD, a hospital, an ambulatory surgical center, etc.) who is responsible for the overall management of the facility; enforces the rules and regulations relative to the level of health care and safety of patients.

COMPLAINT SURVEY - An unannounced survey completed to investigate a complaint filed against a provider. Patients, family members, members of the public, etc., may file a complaint with the Department of Health. Complaints are kept confidential unless directed otherwise.

COMPLIANCE - The provided meets the requirements needed to participate in the Medicare/ Medicaid programs.

COMPLIANCE DIRECTIVE - A directive issued by the Department, citing deficiencies which have come to the attention of the Department through the survey process, or by on-site inspection.

COMPREHENSIVE ASSESSMENT - Regulatory requirements pertaining to a complete and accurate assessment of the patient's physical, mental and social abilities.

COMPREHENSIVE REHABILITATION PROGRAM (CORF) - The facility must provide a coordinated rehabilitation program that includes, at a minimum, physicians' services, physical therapy services, and social or psychological services. It must also be consistent with the plan of treatment and the results of comprehensive patient assessments.

CORE SERVICES - Nursing, physician, medical, social, and counseling services.

CORF - A nonresidential facility that is established and operated exclusively for the purpose of providing diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons, at a single fixed location, by or under the supervision of a physician.

CORF GROUP OF PROFESSIONAL PERSONNEL - A group of professional personnel associated with the facility that develops and periodically reviews policies to govern the services provided by the facility and consists of at least one physician and one professional representing each of the services provided by the facility.

CORF PHYSICAL ENVIRONMENT - The facility must provide a physical environment that protects the health and safety of patients, personnel, and the public. Applicable Federal, State, and local building, fire and safety codes must be met.

CORF PHYSICIAN SERVICES - A facility physician must be present in the facility for a sufficient time to provide medical direction, medical care services, consultation, establish the plan of treatment in cases where a plan has not been established, and participate in plan of treatment reviews.

DEFICIENCY - Any condition which exists contrary to, in violation of, or in non-compliance with state or federal regulations.

DEPARTMENT - Pennsylvania Department of Health.

DIALYSIS - A process by which dissolved substances are removed from a patient's body by diffusion from one fluid compartment to another across a semipermeable membrane. The two types of dialysis that are currently in common use are hemodialysis and peritoneal dialysis.

DIVISION OF INTERMEDIATE CARE FACILITIES - This is the designated Survey Agency within the Department of Health responsible for conducting surveys of Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR) and Intermediate Care Facilities for Persons with Other Related Conditions (ICFs/ORC).

EMPLOYEE - An individual who provides administrative or patient care services to a facility and whose federal withholding tax is reported to the federal government by the facility. "Employee" also refers to a volunteer who performs services for a facility.

END-STAGE RENAL DISEASE (ESRD) - That stage of renal impairment that appears irreversible and permanent, and requires a regular course of dialysis or kidney transplantation to maintain life. The Department surveys hospital based ESRD units who elect to participate in the Medicare program for compliance with federal regulations.

ESRD DIRECTOR - A physician who is responsible for planning, organizing, conducting and directing the professional ESRD services.

ESRD NURSE RESPONSIBLE FOR NURSING SERVICE - A person who is licensed as a registered nurse and (1) has at least 12 months of experience in clinical nursing, and an additional 6 months of experience in nursing care of the patient with permanent kidney failure or undergoing kidney transplantation, including training in and experience with the dialysis process; or (2) has 18 months of experience in nursing care of the patient on maintenance dialysis, or in nursing care of the patient with a kidney transplant, including training in and experience with the dialysis process.

ESRD PATIENT CARE PLAN - A written personalized care plan for each patient of an ESRD facility (including home dialysis patients under the supervision of the ESRD facility), based upon the nature of the patient's illness, the treatment prescribed, and an assessment of the patient's needs.

ESRD PATIENT LONG-TERM PROGRAM - A written program representing the selection of a suitable treatment modality (i.e., dialysis or transplantation) and dialysis setting (e.g., home, self-care) for each patient.

ESRD PATIENT RIGHTS AND RESPONSIBILITIES - All patients have the right to be fully informed of services available in the facility and of related charges including any charges for services not covered under title XVIII of the Social Security Act; the right to be fully informed regarding the facility's reuse of dialysis supplies, including hemodialyzers; the right to be informed regarding their suitability for transplantation and home dialysis; the right to participate in the planning of their medical treatment and to refuse to participate in experimental research; the right to be treated with consideration, respect, and full recognition of their individuality and personal needs, including the need for privacy in treatment; and the right to confidential treatment of their personal and medical records.

FACILITIES - Buildings, equipment and supplies necessary for implementation of services by personnel.

FACILITY STAFF - This is the staff that the facility has designated by their job descriptions and responsibilities. This could be direct care workers, qualified mental retardation professionals, registered nurses, licensed practical nurses, psychologists, physical therapists, speech therapists, occupational therapists, and social workers.

FIELD OFFICE (AAC) - There are eight field offices across the state, which are responsible for the oversight of ambulatory surgical facilities and hospitals.

FIELD OFFICE (HHA) - There are six regional offices located throughout the state that are responsible for monitoring of a designated list of facilities. The six field offices are Norristown, Scranton, Lehigh Valley, Harrisburg, Monessen, and Jackson Center.

FIELD OFFICE (ICF) - There are five regional offices located throughout the state that are responsible for monitoring a designated list of Intermediate Care Facilities. The five field offices are Norristown, Scranton, Harrisburg, Pittsburgh and Jackson Center.

GOVERNING BODY - The owner, board of directors, administrator and/or facility director are responsible for the operation of the facility. They are responsible for managing the facility to ensure the health and safety of the individuals.

HOME HEALTH AGENCY - A facility that provides part time intermittent skilled nursing and one other services, such as physical therapy, speech pathology, occupational therapy, medical social services or home health aides. Services are provided in a patient's home.

HOME HEALTH AGENCY PATIENT RIGHTS - Regulatory requirements which require that patients have a right to be informed of the care and services to be provided to the patient, the right to participate in planning care, the right to be treated with respect and to have property treated with respect. The patient/caregiver has the right to lodge grievances and complaints without the fear of reprisal. The patient has the right of confidentiality of medical record information, and the right to be advised of the extent for liability for payment.

HOME HEALTH AGENCY STAFF - This is the staff that the agency has designated by their job descriptions and responsibilities. This could be registered nurses, licensed practical nurses, physical therapists, speech therapists, occupational therapists, medical social workers or home health aides.

HOME HEALTH AGENCY SURVEY FREQUENCY GUIDELINES -

36-Month Cycle

No condition-level deficiencies in the last three

recertification surveys.

No deficiencies in the Plan of Care or Comprehensive

Assessment conditions of participation in the

previous standard survey.

No complaints resulting in deficiency citations since the

previous survey.

12 - 36-Month Cycle

No condition-level deficiencies with in 24 months of

the most recent survey.

No complaints resulting in deficiency citations since the

previous survey.

Deficiencies in the Plan of Care and/or Comprehensive

Assessment in the previous standard survey, and the

plan of correction was acceptable.

In these situation the following criteria is also used in

determining survey frequency:

Number of standard level deficiencies cited;

Deficiencies cited under Plan of Care and/or

Comprehensive Assessment, and/or

Coordination of Patient Services;

Number and resolution of complaints received;

Changes in management; and Licensure information.

12-Month Cycle

Medicare-approved for less than 3 years at its most

recent survey;

A change of ownership since the last previous

standard survey;

A condition-level deficiency cited within 24 months;

A complaint survey resulting in deficiencies since the

last standard survey; or reviewed by a State,

regional, or national fraud and abuse initiative.

HOSPICE - An organization licensed under the Act to provide a coordinated program of palliative and supportive services in a home, independent living environment or inpatient setting which provides for physical, psychological, social and spiritual care of dying persons and their families. Services are provided by a medically directed interdisciplinary team of professionals and volunteers, and bereavement care is available to the family following the death of the patient. The term shall also be deemed to refer to services provided by such an organization.

HOSPITAL - A facility with an organized medical staff, which provides equipment and services primarily for inpatient care of persons who require definitive diagnosis or treatment, or both, for injury, illness, pregnancy, or other disability.

IMMEDIATE JEOPARDY - This is a crisis situation in which the health and safety of individuals are at risk.

INITIAL COMMENTS - A statement made at the beginning of each deficiency report which tells the reader the name of the facility, the type of survey and the date(s) of the survey.

INPATIENT CARE - Care given to a patient for pain control, symptom management and/or respite purposes that is provided on a 24 hour basis in a facility licensed by the Department.

INPATIENT HOSPICE FACILITY - A facility that provides inpatient hospice care with 24 hour nursing services; meets all Federal, State and local laws, regulations, and codes pertaining to the health and safety of patients; designs and equips areas for the comfort and privacy of each patient and their family members; and adopts and follows appropriate methods and procedures for the isolation of patients with infectious diseases and for dispensing and administering drugs and biologicals.

INTERMEDIATE CARE FACILITY - A facility that provides ongoing evaluation, planning, 24-hour supervision, coordination and integration of health or rehabilitative services to help individuals with mental retardation or other related conditions function at their greatest ability.

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LAST INSPECTION - This is the most recent survey conducted by the Department that is discloseable to the public. This may be a licensure, recertification, complaint, revisit or incident investigation.

LICENSE - No home health agency (HHA), hospital, Class B or C ambulatory surgical center, hospice, birth center (BC) or pediatric extended care center (PECC) in Pennsylvania may operate without a license. A license indicates the provider meets the requirements of the state licensure regulations. The license must be prominently displayed at the provider.

LICENSURE STATUS - The license will reflect a regular or provisional status of the provider or facility.

Regular License - The Department will issue a regular two or three year license to hospitals, or a one year license to an ambulatory surgical facility or home health provider, when that provider is in full compliance with the state licensure regulations.

Provisional License - Is issued if there are numerous deficiencies or a serious specific deficiency that seriously affects the health and safety of the patient(s). The facility must take appropriate action in a timely manner to correct the issues (deficiencies) that affect the health and safety of the patient(s).

LICENSURE SURVEY - An unannounced survey completed to verify that the facility is in compliance with state licensure regulations. The surveys are completed prior to the expiration of the current license and are all unannounced.

LOW RISK INDIVIDUAL - A woman experiencing normal, uncomplicated prenatal course as determined by adequate prenatal care and prospects for a normal, uncomplicated, birth as defined by reasonably and currently accepted criteria of maternal and fetal health.

MANAGEMENT - The owner, board of directors, administrator/director or CEO are responsible for the operation of the facility. They are responsible for managing the facility to ensure the health and safety of the patients.

MEDICAID (Medical Assistance) - Medicaid - Medical Assistance Program that provides payment to participating facilities for services provided to patients that enrolled in the program.

MEDICALLY DEPENDENT - A child eight years of age or younger who because of a medical condition requires continuous therapeutic interventions or skilled nursing supervision which must be prescribed by a licensed physician and administered by or under the direct supervision of a licensed registered nurse.

MEDICARE - The federal reimbursement program that provides medical care under the Social Security Act.

MIDWIFE - A certified midwife holding a valid and current license to practice midwifery in this Commonwealth

MONITORING VISIT - An unannounced survey to note progress towards the facility's correction of identified deficiencies.

N
NEGLECT - The failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.

NONPROFIT - A facility that is not operated or maintained for the purpose of making a profit.

NURSE PRACTITIONER - A registered professional nurse licensed to practice in the state, who meets the state's requirements governing the qualifications of nurse practitioners.

OPT PLAN OF CARE - For each patient there is a written plan of care established by the physician or by the physical therapist or speech-language pathologist who furnishes the services.

PATIENT RIGHTS - Regulatory requirements which require that patients have a right to be treated with respect and to have their property treated with respect. The patient has the right to lodge grievances and complaints without fear of reprisal. The patient has the right of confidentiality of medical record information, and the right to be advised of the extent for liability for payment.

PECC INDIVIDUALIZED CARE PLAN - Designed by the attending physician; the PECC treatment team; a parent or legal guardian; and, when appropriate, the child. The care plan shall be reviewed at least monthly and revised as the child's care needs change.

PECC SERVICES - Development, implementation and monitoring of a comprehensive plan of care, developed with the involvement of the parent of legal guardian, which specifies the medical, nursing, psychological and developmental therapies required by the medically dependent or technologically dependent child served as well as the caregiver training needs of the child's legal guardian.

PECC SUPPORTIVE SERVICES - Or "Contracted Services". Includes speech therapy, occupational therapy, physical therapy, pharmaceutical services, social work, developmental, child life and psychological services.

PEDIATRIC EXTENDED CARE CENTER(PECC) - Any building or buildings, or other place, whether operated for-profit or not-for-profit, which undertakes through its ownership or management to provide basic nonresidential services to more than six medically dependent or technologically dependent children who are related to the owner or operator by blood, marriage or adoption and who require such services.

PHYSICIAN - A Doctor of Medicine or a Doctor of Osteopathy, who holds a current and valid license to practice in this Commonwealth.

PHYSICIAN ASSISTANT - An individual with two or more years advanced training and who is licensed by the State Board of Medicine or by the State Board of Osteopathic Medical Examiners.

PLAN OF CORRECTION - The facility is required to submit a plan of correction for each deficiency listed on the survey report. The plan must include how the facility will correct the identified concerns and what system will be implemented to prevent recurrence. The facility will indicate a target date for the correction of each deficiency. The facility has ten calendar days to submit to the Department of Health an acceptable plan of correction.

PRIVATE PAY- When a patient does not meet the requirements to receive Medicare benefits and is not eligible for Medicaid, payment for their care in the facility becomes their responsibility. The payment is made through either the patient's health insurance coverage or personal funds.

PROFIT - An facility that is operated or maintained for the purpose of making a profit.

PROVIDER AGREEMENT - An agreement that is issued for a one-year period. A survey is completed prior to the issuance of the provider agreement to determine if the facility is in compliance with the federal regulations.

QUALIFIED MENTAL RETARDATION PROFESSIONAL (QMRP) - This is the professional employed by the facility responsible for integrating, coordinating and monitoring each individual's active treatment program.

RECERTIFICATION SURVEY - An unannounced Medicare and/or Medicaid (certification) survey to verify that a facility is in compliance with federal regulations.

REGISTERED NURSE - A nurse licensed to practice in this Commonwealth under the Professional Nursing Law.

REHABILITATION AGENCY -Outpatient Physical Therapy (OPT) - Provides an integrated multidisciplinary rehabilitation program to upgrade the physical functioning of handicapped individuals by bringing specialized rehabilitation staff together to perform as a team to provide at least physical therapy, or speech-language pathology services and social or vocational adjustment services.

RENAL DIALYSIS FACILITY - A unit which is approved to furnish dialysis service(s) directly to ESRD patients.

RESPITE CARE - Short term inpatient care provided on an occasional basis to the patient only when necessary to relieve the family members or other persons caring for the patient.

RESTRAINT - A physical restraint is any manual method or physical or mechanical device that restricts freedom of movement or normal access to one's body, material, or equipment, attached or adjacent to the patient's body that he or she cannot easily remove. A drug used, as a restraint is a medication used to control behavior or to restrict the patient's freedom of movement, and is not a standard treatment for the patient's medical or psychiatric condition.

REVISIT SURVEY - An unannounced Medicare and/or Medicaid (certification) survey conducted after the date identified on the plan of correction by the facility when they determined that all corrections have been made. When a hospital or ambulatory surgical facility notifies the Department that it has corrected its deficiencies, the Department will conduct a survey to ascertain completion of the facility's plan of correction.

RURAL HEALTH CLINIC STAFFING - The clinic has a health care staff that includes one or more physicians. Rural Health Clinic staffs must also include one or more physician's assistants or nurse practitioners.

RURAL HEALTH CLINIC SERVICES - The clinic is primarily engaged in providing outpatient health services.

RURAL HEALTH CLINIC (RHC) - A clinic that is located in a rural area designated as a shortage area.

RHC SHORTAGE AREA - A defined geographic area designated by the Department as having either a shortage of personal health services or a shortage of primary medical care manpower.

SURVEY - The process of evaluation or reevaluation of the compliance of a hospital with the state or federal regulations.

TERMINAL ILLNESS - An illness indicated by a medical prognosis for a life expectancy of 6 months or less if the illness runs its normal course.

TERMINATION ACTION - The Department must terminate a facility's provider agreement if it determines that the identified deficiencies pose immediate jeopardy to the individuals' health and/or safety

UNANNOUNCED SURVEY - Surveys that are initiated without prior notification to the facility before entrance to conduct an inspection. All surveys are unannounced.

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