Section 18.23.070. Definitions for AS 18.23.005 - 18.23.070.

In AS 18.23.005 - 18.23.070, unless the context otherwise requires,
        (1) "administrative staff" means the staff of a hospital or clinic;
        (2) "health care" means professional services rendered by a health care provider or an employee of a health care provider, and services furnished by a sanatorium, rest home, nursing home, boarding home, or other institution for the hospitalization or care of human beings;
        (3) "health care provider" means an acupuncturist licensed under AS 08.06; a chiropractor licensed under AS 08.20; a dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a nurse licensed under AS 08.68; a dispensing optician licensed under AS 08.71; an optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical therapist or occupational therapist licensed under AS 08.84; a physician licensed under AS 08.64; a podiatrist; a psychologist and a psychological associate licensed under AS 08.86; a hospital as defined in AS 47.32.900, including a governmentally owned or operated hospital; and an employee of a health care provider acting within the course and scope of employment;
        (4) "professional service" means service rendered by a health care provider of the type the provider is licensed to render;
        (5) "review organization" means
             (A) a hospital governing body or a committee whose membership is limited to health care providers and administrative staff, except where otherwise provided for by state or federal law, and that is established by a hospital, by a clinic, by one or more state or local associations of health care providers, by an organization of health care providers from a particular area or medical institution, or by a professional standards review organization established under 42 U.S.C. 1320c-1, to gather and review information relating to the care and treatment of patients for the purposes of
                  (i) evaluating and improving the quality of health care rendered in the area or medical institution;
                  (ii) reducing morbidity or mortality;
                  (iii) obtaining and disseminating statistics and information relative to the treatment and prevention of diseases, illness, and injuries;
                  (iv) developing and publishing guidelines showing the norms of health care in the area or medical institution;
                  (v) developing and publishing guidelines designed to keep the cost of health care within reasonable bounds;
                  (vi) reviewing the quality or cost of health care services provided to enrollees of health maintenance organizations;
                  (vii) acting as a professional standards review organization under 42 U.S.C. 1320c;
                  (viii) reviewing, ruling on, or advising on controversies, disputes, or questions between a health insurance carrier or health maintenance organization and one or more of its insured or enrollees; between a professional licensing board, acting under its powers of discipline or license revocation or suspension, and a health care provider licensed by it when the matter is referred to a review organization by the professional licensing board; between a health care provider and the provider's patients concerning diagnosis, treatment, or care, or a charge or fee; between a health care provider and a health insurance carrier or health maintenance organization concerning a charge or fee for health care services provided to an insured or enrollee; or between a health care provider or the provider's patients and the federal or a state or local government, or an agency of the federal or a state or local government;
                  (ix) acting on the recommendation of a credential review committee or a grievance committee;
             (B) the State Medical Board established by AS 08.64.010;
             (C) a committee established by the commissioner of health and social services and approved by the State Medical Board to review public health issues regarding morbidity or mortality; at least 75 percent of the committee members must be health care providers;
             (D) the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Authorities

18.23.005;18.23.060

Notes

Recent Bills that will modify this

SB 14 MEDICAL BOARD; MEDICAL REVIEW ORG.

References

7 AAC 26.745
AS 18.23.060 Parties bound by review.

History

(Sec. 40 ch 102 SLA 1976; am Sec. 36, 37 ch 177 SLA 1978; Sec. 27 ch 2 FSSLA 1987; am Sec. 1 ch 55 SLA 1989; am Sec. 10 ch 6 SLA 1990; am Sec. 2 ch 14 SLA 1991; am Sec. 1 ch 71 SLA 2004; am Sec. 9 ch 57 SLA 2005)