The Florida Senate

395.002  Definitions.--As used in this chapter:

(1)  "Accrediting organizations" means the Joint Commission on Accreditation of Healthcare Organizations, the American Osteopathic Association, the Commission on Accreditation of Rehabilitation Facilities, and the Accreditation Association for Ambulatory Health Care, Inc.

(2)  "Adverse or untoward incident," for purposes of reporting to the agency, means an event over which health care personnel could exercise control, which is probably associated in whole or in part with medical intervention rather than the condition for which such intervention occurred, and which causes injury to a patient, and which:

(a)  Is not consistent with or expected to be a consequence of such medical intervention;

(b)  Occurs as a result of medical intervention to which the patient has not given his or her informed consent;

(c)  Occurs as the result of any other action or lack of any other action on the part of the hospital or personnel of the hospital;

(d)  Results in a surgical procedure being performed on the wrong patient; or

(e)  Results in a surgical procedure being performed that is unrelated to the patient's diagnosis or medical needs.

(3)  "Agency" means the Agency for Health Care Administration.

(4)  "Ambulatory surgical center" means a facility the primary purpose of which is to provide elective surgical care, in which the patient is admitted to and discharged from such facility within the same working day and is not permitted to stay overnight, and which is not part of a hospital. However, a facility existing for the primary purpose of performing terminations of pregnancy, an office maintained by a physician for the practice of medicine, or an office maintained for the practice of dentistry shall not be construed to be an ambulatory surgical center, provided that any facility or office which is certified or seeks certification as a Medicare ambulatory surgical center shall be licensed as an ambulatory surgical center pursuant to s. 395.003.

(5)  "Biomedical waste" means any solid or liquid waste as defined in s. 381.0098(2)(a).

(6)  "Clinical privileges" means the privileges granted to a physician or other licensed health care practitioner to render patient care services in a hospital, but does not include the privilege of admitting patients.

(7)  "Department" means the ¹Department of Health and Rehabilitative Services.

(8)  "Emergency medical condition" means:

(a)  A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:

1.  Serious jeopardy to patient health, including a pregnant woman or fetus.

2.  Serious impairment to bodily functions.

3.  Serious dysfunction of any bodily organ or part.

(b)  With respect to a pregnant woman:

1.  That there is inadequate time to effect safe transfer to another hospital prior to delivery;

2.  That a transfer may pose a threat to the health and safety of the patient or fetus; or

3.  That there is evidence of the onset and persistence of uterine contractions or rupture of the membranes.

(9)  "Emergency services and care" means medical screening, examination, and evaluation by a physician, or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician, to determine if an emergency medical condition exists and, if it does, the care, treatment, or surgery by a physician necessary to relieve or eliminate the emergency medical condition, within the service capability of the facility.

(10)  "General hospital" means any facility which meets the provisions of subsection (12) and which regularly makes its facilities and services available to the general population.

(11)  "Governmental unit" means the state or any county, municipality, or other political subdivision, or any department, division, board, or other agency of any of the foregoing.

(12)  "Hospital" means any establishment that:

(a)  Offers services more intensive than those required for room, board, personal services, and general nursing care, and offers facilities and beds for use beyond 24 hours by individuals requiring diagnosis, treatment, or care for illness, injury, deformity, infirmity, abnormality, disease, or pregnancy; and

(b)  Regularly makes available at least clinical laboratory services, diagnostic X-ray services, and treatment facilities for surgery or obstetrical care, or other definitive medical treatment of similar extent.

However, the provisions of this chapter do not apply to any institution conducted by or for the adherents of any well-recognized church or religious denomination that depends exclusively upon prayer or spiritual means to heal, care for, or treat any person. For purposes of local zoning matters, the term "hospital" includes a medical office building located on the same premises as a hospital facility, provided the land on which the medical office building is constructed is zoned for use as a hospital; provided the premises were zoned for hospital purposes on January 1, 1992.

(13)  "Hospital bed" means a hospital accommodation which is ready for immediate occupancy, or is capable of being made ready for occupancy within 48 hours, excluding provision of staffing, and which conforms to minimum space, equipment, and furnishings standards as specified by rule of the department for the provision of services specified in this section to a single patient.

(14)  "Initial denial determination" means a determination by a private review agent that the health care services furnished or proposed to be furnished to a patient are inappropriate, not medically necessary, or not reasonable.

(15)  "Injury," for purposes of reporting to the agency, means any of the following outcomes if caused by an adverse or untoward incident:

(a)  Death;

(b)  Brain damage;

(c)  Spinal damage;

(d)  Permanent disfigurement;

(e)  Fracture or dislocation of bones or joints;

(f)  Any condition requiring definitive or specialized medical attention which is not consistent with the routine management of the patient's case or patient's preexisting physical condition;

(g)  Any condition requiring surgical intervention to correct or control;

(h)  Any condition resulting in transfer of the patient, within or outside the facility, to a unit providing a more acute level of care;

(i)  Any condition that extends the patient's length of stay; or

(j)  Any condition that results in a limitation of neurological, physical, or sensory function which continues after discharge from the facility.

(16)  "Intensive residential treatment programs for children and adolescents" means a specialty hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations which provides 24-hour care and which has the primary functions of diagnosis and treatment of patients under the age of 18 having psychiatric disorders in order to restore such patients to an optimal level of functioning.

(17)  "Licensed facility" means a hospital or ambulatory surgical center licensed in accordance with this chapter.

(18)  "Lifesafety" means the control and prevention of fire and other life-threatening conditions on a premises for the purpose of preserving human life.

(19)  "Medical staff" means physicians licensed under chapter 458 or chapter 459 with privileges in a licensed facility, as well as other licensed health care practitioners with clinical privileges as approved by a licensed facility's governing board.

(20)  "Medically necessary transfer" means a transfer made necessary because the patient is in immediate need of treatment for an emergency medical condition for which the facility lacks service capability or is at service capacity.

(21)  "Person" means any individual, partnership, corporation, association, or governmental unit.

(22)  "Premises" means those buildings, beds, and equipment located at the address of the licensed facility and all other buildings, beds, and equipment for the provision of hospital or ambulatory surgical care located in such reasonable proximity to the address of the licensed facility as to appear to the public to be under the dominion and control of the licensee.

(23)  "Private review agent" means any person or entity which performs utilization review services for third-party payors on a contractual basis for outpatient or inpatient services. However, the term shall not include full-time employees, personnel, or staff of health insurers, health maintenance organizations, or hospitals, or wholly owned subsidiaries thereof or affiliates under common ownership, when performing utilization review for their respective hospitals, health maintenance organizations, or insureds of the same insurance group. For this purpose, health insurers, health maintenance organizations, and hospitals, or wholly owned subsidiaries thereof or affiliates under common ownership, include such entities engaged as administrators of self-insurance as defined in s. 624.031.

(24)  "Service capability" means all services offered by the facility where identification of services offered is evidenced by the appearance of the service in a patient's medical record or itemized bill.

(25)  "At service capacity" means the temporary inability of a hospital to provide a service which is within the service capability of the hospital, due to maximum use of the service at the time of the request for the service.

(26)  "Specialty bed" means a bed, other than a general bed, designated on the face of the hospital license for a dedicated use.

(27)  "Specialty hospital" means any facility which meets the provisions of subsection (12), and which regularly makes available either:

(a)  The range of medical services offered by general hospitals, but restricted to a defined age or gender group of the population;

(b)  A restricted range of services appropriate to the diagnosis, care, and treatment of patients with specific categories of medical or psychiatric illnesses or disorders; or

(c)  Intensive residential treatment programs for children and adolescents as defined in subsection (16).

(28)  "Stabilized" means, with respect to an emergency medical condition, that no material deterioration of the condition is likely, within reasonable medical probability, to result from the transfer of the patient from a hospital.

(29)  "Utilization review" means a system for reviewing the medical necessity or appropriateness in the allocation of health care resources of hospital services given or proposed to be given to a patient or group of patients.

(30)  "Utilization review plan" means a description of the policies and procedures governing utilization review activities performed by a private review agent.

(31)  "Validation inspection" means an inspection of the premises of a licensed facility by the agency to assess whether a review by an accrediting organization has adequately evaluated the licensed facility according to minimum state standards.

History.--ss. 1, 4, ch. 82-125; ss. 26, 30, ch. 82-182; s. 33, ch. 87-92; s. 52, ch. 88-130; s. 4, ch. 89-527; s. 12, ch. 90-295; ss. 3, 98, ch. 92-289; s. 724, ch. 95-148.

¹Note.--The Department of Health and Rehabilitative Services was redesignated as the Department of Children and Family Services by s. 5, ch. 96-403, and the Department of Health was created by s. 8, ch. 96-403.