Terms Used In Louisiana Revised Statutes > Title 46 > Chapter 3 > Part XIII - Medicaid Managed Care

• Adverse determination: means any of the following relative to a claim by a provider for payment for a healthcare service rendered by the provider to an enrollee of the Medicaid managed care organization:

              (a) A decision by a managed care organization that denies a claim in whole or in part. See Louisiana Revised Statutes 46:460.51

• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
• Agency: means and includes the boards, commissions, departments, agencies, offices, officers, and other instrumentalities, or any or all of these, within the executive branch of state government which are abolished by this Title or which are transferred and placed within departments of the state government created and established or continued by this Title or transferred to and placed within the office of the governor as provided by this Title. See Louisiana Revised Statutes 36:3
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Applicant: means a healthcare provider seeking to be approved or credentialed by a managed care organization to provide healthcare services to Medicaid enrollees. See Louisiana Revised Statutes 46:460.51
• Appraisal: A determination of property value.
• Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
• Attest: means providing the following services, subject to the exceptions provided for in La. See Louisiana Revised Statutes 37:73
• Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
• Board: means the State Board of Certified Public Accountants of Louisiana. See Louisiana Revised Statutes 37:73
• Certificate: means a certificate as a certified public accountant issued pursuant to the provisions of this Part, as follows:

              (a) An "active certificate" is granted to or renewed by an individual who has met all requirements pursuant to the provisions of this Part, including the experience requirement. See Louisiana Revised Statutes 37:73

• Certificate of documentation: means a certificate issued by the United States Coast Guard for a vessel documented under 46 U. See Louisiana Revised Statutes 34:852.2
• Certificate of origin: means a document establishing the initial chain of ownership, such as a manufacturer's certificate of origin (MCO) or statement of origin (MSO), or an importer's certificate of origin (ICO) or statement of origin (ISO), or a builder's certification (Form CG-1261, under 46 C. See Louisiana Revised Statutes 34:852.2
• Chambers: A judge's office.
• Civil proceeding: means any civil judicial action, arbitration, administrative proceeding, review panel pursuant to this Chapter, or proceeding before the State Board of Certified Public Accountants of Louisiana. See Louisiana Revised Statutes 37:73
• Claim: means any cause of action against a certified public accountant or firm, regardless of the legal basis of the claim, including but not limited to tort, fraud, breach of contract, or any other legal basis, arising out of any engagement to provide professional services, including but not limited to the following:

  (a)  The providing of attest services as defined in La. See Louisiana Revised Statutes 37:101

• Claimant: means any person having an interest or right to assert a claim, whether for himself or on behalf of another. See Louisiana Revised Statutes 37:101
• Clerk of court: An officer appointed by the court to work with the chief judge in overseeing the court's administration, especially to assist in managing the flow of cases through the court and to maintain court records.
• Client: means a person or entity that agrees with a licensee to receive any professional service. See Louisiana Revised Statutes 37:73
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Continuance: Putting off of a hearing ot trial until a later time.
• Contract: A legal written agreement that becomes binding when signed.
• Conviction: A judgement of guilt against a criminal defendant.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• CPA firm: means any sole proprietorship, corporation, partnership, registered limited liability partnership, limited liability company, or other form of organization issued a permit to practice in accordance with the provisions of this Part. See Louisiana Revised Statutes 37:73
• CPA-Retired: means either of the following:

              (i) A licensee holding an active certificate for a minimum of twenty consecutive years, who has reached the age of fifty-five years, and is no longer an owner, partner, shareholder, member, contractor, contractee, or employee of a CPA firm. See Louisiana Revised Statutes 37:73

• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Dealer: means any person who engages wholly or in part in the business of buying, selling, or exchanging for value new or used vessels or outboard motors, or both, either outright or on conditional sale, bailment, lease, chattel mortgage, or otherwise. See Louisiana Revised Statutes 34:852.2
• Decedent: A deceased person.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Dental coordinated care network: means a managed care organization or prepaid coordinated care network, as defined in this Section, that provides or administers only dental benefits for Medicaid recipients. See Louisiana Revised Statutes 46:460.51
• Department: means the Department of Wildlife and Fisheries and its duly authorized representatives. See Louisiana Revised Statutes 34:852.2
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• Dependent: A person dependent for support upon another.
• Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Dismissal: The dropping of a case by the judge without further consideration or hearing. ^Source:
• distrain: as used in this Chapter shall be construed to mean the right to levy upon and seize and sell, or the levying upon or seizing and selling, of any property or rights to property of the taxpayer including goods, chattels, effects, stocks, securities, bank accounts, evidences of debt, wages, real estate and other forms of property, by the collector or his authorized assistants, for the purpose of satisfying any assessment of tax, penalty or interest due. See Louisiana Revised Statutes 47:337.57
• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• Enrollee: means an individual who is enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
• Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
• Escrow: Money given to a third party to be held for payment until certain conditions are met.
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Executor: A male person named in a will to carry out the decedent
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• Fiduciary: A trustee, executor, or administrator.
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Fraud: Intentional deception resulting in injury to another.
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Good moral character: means the propensity to provide professional services in a fair, honest, and open manner and the lack of history of any dishonest or felonious acts. See Louisiana Revised Statutes 37:73
• Hull identification number: means the number assigned to a vessel under Subpart C of 33 C. See Louisiana Revised Statutes 34:852.2
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Instrument: means any instrument, whether or not negotiable, which evidences the indebtedness of one or more persons. See Louisiana Revised Statutes 9:5321
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Jurisprudence: The study of law and the structure of the legal system.
• Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Legatee: A beneficiary of a decedent
• License: means an active certificate of certified public accountant, pursuant to Subparagraph(3)(a) of this Section, or a CPA firm's permit to practice issued in accordance with the provisions of this Part. See Louisiana Revised Statutes 37:73
• Licensee: means the holder of a license. See Louisiana Revised Statutes 37:73
• Lien: A claim against real or personal property in satisfaction of a debt.
• Lienholder: means a person holding a security interest. See Louisiana Revised Statutes 34:852.2
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Manager: means a manager of a limited liability company or a limited liability partnership. See Louisiana Revised Statutes 37:73
• Manufacturer: means any person engaged in the business of manufacturing or importing new vessels or outboard motors for the purpose of sale or trade. See Louisiana Revised Statutes 34:852.2
• Member: means a member of a limited liability company or a limited liability partnership. See Louisiana Revised Statutes 37:73
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
• Oath: A promise to tell the truth.
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Office: means each principal operational unit within a department, except the executive office of the secretary. See Louisiana Revised Statutes 36:3
• operation: means all operations of a vessel or outboard motor when it is at the pier, idle in the water, at anchor, or being propelled through the water. See Louisiana Revised Statutes 34:852.2
• Outboard motor: means a mechanical combustion engine manufactured to produce a twenty-five or more horsepower engine and designed to attach outboard of the transom of a vessel. See Louisiana Revised Statutes 34:852.2
• Oversight: Committee review of the activities of a Federal agency or program.
• Owner: means a person, other than a secured party, having property rights in, or title to, a vessel or outboard motor. See Louisiana Revised Statutes 34:852.2
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Peer review: means a study, appraisal, or review of one or more aspects of the professional work of a CPA firm that performs attest services by a person or persons who hold licenses and who are not affiliated with the CPA firm being reviewed. See Louisiana Revised Statutes 37:73
• Permit: means a permit to practice as a CPA firm issued pursuant to the provisions of this Part or pursuant to corresponding provisions of law of another state. See Louisiana Revised Statutes 37:73
• Person: means any natural person or individual, firm, partnership, corporation, association, limited liability company, or other entity. See Louisiana Revised Statutes 34:852.2
• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• Personal property: All property that is not real property.
• personal watercraft: means a vessel which uses an inboard motor powering a water jet pump as its primary source of motive power and which is designed to be operated by a person sitting, standing, or kneeling on the vessel, rather than the conventional manner of sitting or standing inside the vessel. See Louisiana Revised Statutes 34:855.2
• Pilot: means a New Orleans and Baton Rouge Steamship Pilot, as designated in La. See Louisiana Revised Statutes 34:1041
• Plaintiff: The person who files the complaint in a civil lawsuit.
• Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
• Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.
• Policy or procedure: shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services. See Louisiana Revised Statutes 46:460.51
• Political subdivision: means a parish, municipality, and any other unit of local government, including a school board and a special district, authorized by law to levy and collect a sales and use tax. See Louisiana Revised Statutes 47:337.6
• Possesses: means the person has acquired rights in or title to a vessel or outboard motor by virtue of a gift, donation, raffle, or exchange or the person built the vessel or outboard motor themselves. See Louisiana Revised Statutes 34:852.2
• Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. ^{Source: OCC}
• Prepaid Coordinated Care Network: means a private entity that contracts with the department to provide Medicaid benefits and services to Louisiana Medicaid managed care program enrollees in exchange for a monthly prepaid capitated amount per member. See Louisiana Revised Statutes 46:460.51
• Preparation of financial statement: means an engagement by a licensee to prepare financial statements for an entity but not to perform a compilation, review, or audit with respect to those financial statements and as provided in the American Institute of Certified Public Accountants' Statement on Standards for Accounting and Review Services. See Louisiana Revised Statutes 37:73
• Primary care case management: means a system under which an entity contracts with the state to furnish case management services that include but are not limited to the location, coordination, and monitoring of primary healthcare services to Medicaid beneficiaries. See Louisiana Revised Statutes 46:460.51
• Probable cause: A reasonable ground for belief that the offender violated a specific law.
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• Professional: means arising out of or related to the specialized knowledge or skills associated with CPAs. See Louisiana Revised Statutes 37:73
• Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
• provider: means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution that provides healthcare or professional services to individuals enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
• Quorum: The number of legislators that must be present to do business.
• Recipient: means the person who has received assistance under this Title. See Louisiana Revised Statutes 46:1
• Report: means , when used with reference to any attest services, an opinion, report, or other form of language that states or implies an assurance as to the reliability of any financial statement or assertion. See Louisiana Revised Statutes 37:73
• Rule: means any rule, regulation, or other written directive of general application adopted by the board in accordance with the Administrative Procedure Act. See Louisiana Revised Statutes 37:73
• Rural Property: means a tract of land which is at least forty acres in area and from which at least seventy-five percent of the income derived is from agricultural or livestock purposes or mineral income and which is not located within the territorial limits of any incorporated municipality. See Louisiana Revised Statutes 9:5321
• Secretary: means the secretary of the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• Secretary: means the officer appointed by the governor as the executive head and chief administrative officer of certain departments created and provided for by this Title. See Louisiana Revised Statutes 36:3
• secretary of revenue: means the secretary of the Department of Revenue for the state of Louisiana. See Louisiana Revised Statutes 47:337.6
• Security interest: means an interest that is reserved or created by an agreement that secures payment or performance of an obligation. See Louisiana Revised Statutes 34:852.2
• Service of process: The service of writs or summonses to the appropriate party.
• services: means the services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 46:460.51
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Society: means the Society of Louisiana Certified Public Accountants. See Louisiana Revised Statutes 37:101
• Standardized information: means the customary universal data concerning an applicant's identity, education, and professional experience relative to a managed care organization's credentialing process including but not limited to name, address, telephone number, date of birth, social security number, educational background, state licensing board number, residency program, internship, specialty, subspecialty, fellowship, or certification by a regional or national healthcare or medical specialty college, association or society, prior and current place of employment, an adverse medical review panel opinion, a pending professional liability lawsuit, final disposition of a professional liability settlement or judgment, and information mandated by health insurance issuer accrediting organizations. See Louisiana Revised Statutes 46:460.51
• State: means any state of the United States, the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, and the Commonwealth of the Northern Mariana Islands. See Louisiana Revised Statutes 37:73
• Statute: A law passed by a legislature.
• Subpoena: A command to a witness to appear and give testimony.
• substantially equivalent: means a determination by the board, or its designee, that the education, examination, and experience requirements contained in the statutes and administrative rules of another state or jurisdiction are comparable to or exceed the education, examination, and experience requirements of this state or that an individual CPA's education, examination, and experience qualifications are comparable to or exceed the education, examination, and experience requirements of this state. See Louisiana Revised Statutes 37:73
• Subtitle: means and includes all the Chapters in Subtitle II of this Title 47 and any other Title of the Louisiana Revised Statutes of 1950 except the provisions of Chapter 1 of Subtitle IV of Title 47 of the Louisiana Revised Statutes of 1950 and estate taxes for the assessment, collection, administration, and enforcement of taxes, fees, licenses, penalties, and interest due the state of Louisiana which have been delegated to the Department of Revenue. See Louisiana Revised Statutes 47:1501
• Telehealth: has the meaning ascribed in La. See Louisiana Revised Statutes 46:460.51
• Temporary restraining order: Prohibits a person from an action that is likely to cause irreparable harm. This differs from an injunction in that it may be granted immediately, without notice to the opposing party, and without a hearing. It is intended to last only until a hearing can be held.
• Testify: Answer questions in court.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
• Transcript: A written, word-for-word record of what was said, either in a proceeding such as a trial or during some other conversation, as in a transcript of a hearing or oral deposition.
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• Trustee: A person or institution holding and administering property in trust.
• Undocumented vessel: means a vessel for which a certificate of documentation has not been issued by the United States Coast Guard under 46 U. See Louisiana Revised Statutes 34:852.2
• Uniform Commercial Code: A set of statutes enacted by the various states to provide consistency among the states' commercial laws. It includes negotiable instruments, sales, stock transfers, trust and warehouse receipts, and bills of lading. ^{Source: OCC}
• Venue: The geographical location in which a case is tried.
• Verdict: The decision of a petit jury or a judge.
• verification supporting statement: means the documentation confirming the information submitted by an applicant for a credentialing application from a specifically named entity or a regional, national, or general data depository providing primary source verification including but not limited to a college, university, medical school, teaching hospital, healthcare facility or institution, state licensing board, federal agency or department, professional liability insurer, or the National Practitioner Data Bank. See Louisiana Revised Statutes 46:460.51
• Vessel: means every description of watercraft and air boats, including homemade boats, other than a seaplane on the water, used or capable of being used as a means of transportation on water, valued in excess of two thousand five hundred dollars, to be principally operated on the waters of this state, required to be numbered, not held as inventory for sale or lease, and transferred for the first time on or after July 1, 2008. See Louisiana Revised Statutes 34:852.2
• Writ: A formal written command, issued from the court, requiring the performance of a specific act.