28 Pa. Code § 915.3

Current through Register Vol. 54, No. 45, November 9, 2024

Section 915.3 - Definitions

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

Act-The Health Care Cost Containment Act (35 P. S. §§ 449.1-449.19).

Category-A specifically defined, mutually exclusive division in a classification system.

Cell-The smallest unit or compartment of a statistical table or tabulation.

Council-The Health Care Cost Containment Council.

Data or raw data-Data collected by the Council or the Council's data vendor under section 6 of the act (35 P. S. § 449.6).

Data source-The term includes, but is not limited to, the following:

(i) A hospital.

(ii) An ambulatory service facility.

(iii) A physician.

(iv) A health maintenance organization as the term is defined in the Health Maintenance Organization Act (40 P. S. §§ 1551-1567).

(v) A hospital, medical or health service plan with a certificate of authority issued by the Insurance Department, including, but not limited to, hospital plan corporations as defined in 40 Pa.C.S. Chapter 61 (relating to hospital plan corporations) and professional health service plan corporations as defined in 40 Pa.C.S. Chapter 63 (relating to professional health services plan corporations).

(vi) A commercial insurer with a certificate of authority issued by the Insurance Department providing health or accident insurance.

(vii) A self-insured employer providing health or accident coverage or benefits for employes employed in this Commonwealth.

(viii) An administrator of a self-insured or partially self-insured health or accident plan providing covered services in this Commonwealth.

(ix) A health and welfare fund that provides health or accident benefits or insurance pertaining to covered services in this Commonwealth.

(x) The Department of Public Welfare for those covered services it purchases or provides through the Medical Assistance program under the Public Welfare Code (62 P. S. §§ 101-1411).

(xi) Other payors for covered services in this Commonwealth, other than an individual.

Executive Director-The Executive Director of the Council.

Nondisclosable data-Data pertaining to an individual's health care service encounter that, if disclosed, violate the provisions concerning release of and access to Council data contained in the act. These data are set forth in Appendix A.

Nonprotected data-Data pertaining to an individual's health care service encounter that may be released by the Council without violating provisions concerning release of and access to Council data contained in the act. These data are set forth in Appendix C.

Other parties-Entities other than purchasers to which the Council may release data under the act.

Protected data-Data pertaining to an individual's health care service encounter that may only be released by the Council under the act in specific circumstances based on criteria developed by the Council. These data are set forth in Appendix B.

Proxy patient identifier-A unique number assigned by the Council to an individual patient which will not breech patient confidentiality provisions contained in the act or in this chapter.

Purchaser-A corporation, labor organization or other entity that purchases benefits which provide covered services for employes or members, either through a health care insurer or by means of a self-funded program of benefits, and a certified bargaining representative that represents groups of employes for whom employers purchase a program of benefits which provide covered services. The term does not include entities defined in the act as "health care insurers."

28 Pa. Code § 915.3