Actuarial opinion: means an opinion issued by an actuary in accordance with Actuarial Standard of Practice No. See Florida Statutes 651.011
Actuarial study: means an analysis prepared for an individual facility, or consolidated for multiple facilities, for either a certified provider, as of a current valuation date or the most recent fiscal year, or for an applicant, as of a projected future valuation date, which includes an actuary's opinion as to whether such provider or applicant is in satisfactory actuarial balance in accordance with Actuarial Standard of Practice No. See Florida Statutes 651.011
Actuary: means an individual who is qualified to sign an actuarial opinion in accordance with the American Academy of Actuaries' qualification standards and who is a member in good standing of the American Academy of Actuaries. See Florida Statutes 651.011
Adverse determination: means a coverage determination by an organization that an admission, availability of care, continued stay, or other health care service has been reviewed and, based upon the information provided, does not meet the organization's requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and coverage for the requested service is therefore denied, reduced, or terminated. See Florida Statutes 641.47
Advertising: means the dissemination of written, visual, or electronic information by a provider, or any person affiliated with or controlled by a provider, to potential residents or their representatives for the purpose of inducing such persons to subscribe to or enter into a contract for continuing care or continuing care at-home. See Florida Statutes 651.011
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.
Amortization: Paying off a loan by regular installments.
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.
Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
Appraisal: A determination of property value.
Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
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.
Basic services: includes any of the following: emergency care, physician care other than hospital inpatient physician services, ambulatory diagnostic treatment, and preventive health care services. See Florida Statutes 641.402
Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
care: means , pursuant to a contract, furnishing shelter and nursing care or personal services to a resident who resides in a facility, whether such nursing care or personal services are provided in the facility or in another setting designated in the contract for continuing care, by an individual not related by consanguinity or affinity to the resident, upon payment of an entrance fee. See Florida Statutes 651.011
Clinical peer: means a health care professional in the same or similar specialty as typically manages the medical condition, procedure, or treatment under review. See Florida Statutes 641.47
Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
Complaint: means any expression of dissatisfaction by a subscriber, including dissatisfaction with the administration, claims practices, or provision of services, which relates to the quality of care provided by a provider pursuant to the organization's contract and which is submitted to the organization or to a state agency. See Florida Statutes 641.47
Concurrent review: means utilization review conducted during a patient's hospital stay or course of treatment. See Florida Statutes 641.47
Continuing care at-home: means , pursuant to a contract other than a contract described in subsection (5), furnishing to a resident who resides outside the facility the right to future access to shelter and nursing care or personal services, whether such services are provided in the facility or in another setting designated in the contract, by an individual not related by consanguinity or affinity to the resident, upon payment of an entrance fee. See Florida Statutes 651.011
Contract: A legal written agreement that becomes binding when signed.
Controlling company: means any corporation, trust, or association that directly or indirectly owns 25 percent or more of:
(a) The voting securities of one or more providers that are stock corporations; or
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.
Corrective order: means an order issued by the office which specifies corrective actions that the office determines are required in accordance with this chapter or commission rule. See Florida Statutes 651.011
Credit report: A detailed report of an individual's credit history prepared by a credit bureau and used by a lender in determining a loan applicant's creditworthiness. Source: OCC
Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
Days cash on hand: means the quotient obtained by dividing the value of paragraph (a) by the value of paragraph (b). See Florida Statutes 651.011
Debt service coverage ratio: means the quotient obtained by dividing the value of paragraph (a) by the value of paragraph (b). See Florida Statutes 651.011
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:
Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. Source: OCC
Emergency medical condition: means :
(a) A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain or other acute symptoms, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
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 for a covered service by a physician necessary to relieve or eliminate the emergency medical condition within the service capability of a hospital. See Florida Statutes 641.47
Entrance fee: means an initial or deferred payment of a sum of money or property made as full or partial payment for continuing care or continuing care at-home. See Florida Statutes 651.011
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.
Facility: means a place where continuing care is furnished and may include one or more physical plants on a primary or contiguous site or an immediately accessible site. See Florida Statutes 651.011
Felony: A crime carrying a penalty of more than a year in prison.
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.
Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. Source: OCC
Fraud: Intentional deception resulting in injury to another.
Geographic area: means the county or counties, or any portion of a county or counties, within which the health maintenance organization provides or arranges for comprehensive health care services to be available to its subscribers. See Florida Statutes 641.47
Grievance: means a written complaint submitted by or on behalf of a subscriber to an organization or a state agency regarding the:
(a) Availability, coverage for the delivery, or quality of health care services, including a complaint regarding an adverse determination made pursuant to utilization review;
(b) Claims payment, handling, or reimbursement for health care services; or
(c) Matters pertaining to the contractual relationship between a subscriber and an organization. See Florida Statutes 641.47
immediately accessible site: means a parcel of real property separated by a reasonable distance from the facility as measured along public thoroughfares, and the term "primary or contiguous site" means the real property contemplated in the feasibility study required by this chapter. See Florida Statutes 651.011
impairment: means that either of the following has occurred:
Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
Insolvency: means the condition in which a provider is unable to pay its obligations as they come due in the normal course of business. See Florida Statutes 651.011
insolvency: means the inability of a prepaid health clinic to discharge its liabilities as they become due in the normal course of business. See Florida Statutes 641.402
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.
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
Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
Lien: A claim against real or personal property in satisfaction of a debt.
Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
management company: means a person who administers the day-to-day business operations of a facility for a provider, subject to the policies, directives, and oversight of the provider. See Florida Statutes 651.011
Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
Mortgage loan: A loan made by a lender to a borrower for the financing of real property. Source: OCC
National Bank: A bank that is subject to the supervision of the Comptroller of the Currency. The Office of the Comptroller of the Currency is a bureau of the U.S. Treasury Department. A national bank can be recognized because it must have "national" or "national association" in its name. Source: OCC
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.
Obligated group: means one or more entities that jointly agree to be bound by a financing structure containing security provisions and covenants applicable to the group. See Florida Statutes 651.011
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.
Occupancy: means the total number of occupied independent living units, assisted living units, and skilled nursing beds in a facility divided by the total number of units and beds in that facility, excluding units and beds that are unavailable to market or that are reserved by prospective residents. See Florida Statutes 651.011
Oversight: Committee review of the activities of a Federal agency or program.
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.
person: includes individuals, children, firms, associations, joint adventures, partnerships, estates, trusts, business trusts, syndicates, fiduciaries, corporations, and all other groups or combinations. See Florida Statutes 1.01
Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
Prepaid health clinic: means any organization authorized under this part which provides, either directly or through arrangements with other persons, basic services to persons enrolled with such organization, on a prepaid per capita or prepaid aggregate fixed-sum basis, including those basic services which subscribers might reasonably require to maintain good health. See Florida Statutes 641.402
Prepaid health clinic contract: means any contract entered into by a prepaid health clinic with a subscriber or group of subscribers to provide any of the basic services in exchange for a prepaid per capita or prepaid aggregate fixed sum. See Florida Statutes 641.402
Probable cause: A reasonable ground for belief that the offender violated a specific law.
Provider: means the owner or operator, whether a natural person, partnership or other unincorporated association, however organized, trust, or corporation, of an institution, building, residence, or other place, whether operated for profit or not, which owner or operator provides continuing care or continuing care at-home for a fixed or variable fee, or for any other remuneration of any type, whether fixed or variable, for the period of care, payable in a lump sum or lump sum and monthly maintenance charges or in installments. See Florida Statutes 651.011
Provider: means any physician or person other than a hospital that furnishes health care services and is licensed or authorized to practice in this state. See Florida Statutes 641.402
Provider: means any physician, hospital, or other institution, organization, or person that furnishes health care services and is licensed or otherwise authorized to practice in the state. See Florida Statutes 641.47
Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
Records: means all documents; correspondence; and financial, directory, and personnel information and data maintained by a provider pursuant to this chapter, regardless of the physical form, characteristics, or means of transmission. See Florida Statutes 651.011
Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
Regulatory action level event: means that any two of the following have occurred:
(a) The provider's debt service coverage ratio is less than the greater of the minimum ratio specified in the provider's bond covenants or lending agreement for long-term financing or 1. See Florida Statutes 651.011
Reporting period: means the particular span of time by or for which accounts are redeemed on an annualized basis. See Florida Statutes 641.402
Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
Resident: means a purchaser of, a nominee of, or a subscriber to a continuing care or continuing care at-home contract. See Florida Statutes 651.011
Retrospective review: means a review, for coverage purposes, of medical necessity conducted after services have been provided to a patient. See Florida Statutes 641.47
Service of process: The service of writs or summonses to the appropriate party.
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.
Shelter: means an independent living unit, room, apartment, cottage, villa, personal care unit, nursing bed, or other living area within a facility set aside for the exclusive use of one or more identified residents. See Florida Statutes 651.011
Statute: A law passed by a legislature.
Subpoena: A command to a witness to appear and give testimony.
Subscriber: means an individual who has contracted, or on whose behalf a contract has been entered into, with a prepaid health clinic for health care services. See Florida Statutes 641.402
Subscriber: means an individual who has contracted, or on whose behalf a contract has been entered into, with a health maintenance organization for health care services. See Florida Statutes 641.47
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.
Trustee: A person or institution holding and administering property in trust.
Urgent grievance: means an adverse determination when the standard timeframe of the grievance procedure would seriously jeopardize the life or health of a subscriber or would jeopardize the subscriber's ability to regain maximum function. See Florida Statutes 641.47
writing: includes handwriting, printing, typewriting, and all other methods and means of forming letters and characters upon paper, stone, wood, or other materials. See Florida Statutes 1.01