Terms Used In Louisiana Revised Statutes > Title 33 > Chapter 1 > Part I - Establishment and Designation of Municipalities

• Administrator: means the secretary of the Louisiana Workforce Commission. See Louisiana Revised Statutes 23:1472
• Administrator-in-training: means an individual who has applied to the board for a license as a nursing facility administrator, and who meets the requirements for licensing, and whose administrator-in-training program is approved by the board, all in accordance with rules and regulations promulgated by the board. See Louisiana Revised Statutes 37:2501
• Adverse determination: means any of the following:

              (a) A determination by a health insurance issuer or its designee utilization review organization that, based upon the information provided, a request for a benefit under the health insurance issuer's health benefit plan upon application of any utilization review technique does not meet the health insurance issuer's requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness or is determined to be experimental or investigational and the requested benefit is therefore denied, reduced, or terminated or payment is not provided or made, in whole or in part, for the benefit. See Louisiana Revised Statutes 22:2392

• Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
• 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 an individual who has made application to the board for the issuance or reinstatement of any license, reciprocity request, or any other designation deemed necessary to become a nursing home administrator that the board is authorized by law to issue. See Louisiana Revised Statutes 37:2501
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Authorized representative: means any of the following:

              (a) A person to whom a covered person has given express written consent to represent the covered person for purposes of this Chapter. See Louisiana Revised Statutes 22:2392

• Base period: means the first four of the last five complete calendar quarters immediately preceding the first day of an individual's benefit year. See Louisiana Revised Statutes 23:1472
• Benefits: means the money payments payable to an individual, as provided in this Chapter, with respect to his unemployment. See Louisiana Revised Statutes 23:1472
• benefits: means those health care services to which a covered person is entitled under the terms of a health benefit plan. See Louisiana Revised Statutes 22:2392
• Board: means the Louisiana State Board of Medical Examiners. See Louisiana Revised Statutes 37:611
• Board: shall mean the Louisiana Board for Hearing Aid Dealers. See Louisiana Revised Statutes 37:2442
• Board: means the Board of Examiners of Nursing Facility Administrators. See Louisiana Revised Statutes 37:2501
• Board of trustees: means the board provided for in Part V of this Chapter to administer the retirement system. See Louisiana Revised Statutes 11:701
• Bureau: means the Louisiana Bureau of Criminal Identification and Information of the office of state police within the Department of Public Safety and Corrections. See Louisiana Revised Statutes 37:2501
• Business day: means a day of normal business operation other than federally recognized holidays. See Louisiana Revised Statutes 22:2392
• 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.
• Clinical peer: means a physician or other health care professional who holds a nonrestricted license in a state of the United States and in the same or similar specialty as typically manages the medical condition, procedure, or treatment under review. See Louisiana Revised Statutes 22:2392
• Clinical review criteria: means the written screening procedures, decision abstracts, clinical protocols, and practice guidelines used by the health insurance issuer to determine the medical necessity and appropriateness of health care services including those used in the determination of an item or health care service as experimental. See Louisiana Revised Statutes 22:2392
• Commission: means the Louisiana Workforce Commission. See Louisiana Revised Statutes 23:1
• Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:2392
• commissioner: as used in this Chapter , means the commissioner of the Louisiana Department of Agriculture and Forestry. See Louisiana Revised Statutes 37:2202
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Contributions: means the money payments to the state unemployment compensation fund, required by this Chapter. See Louisiana Revised Statutes 23:1472
• Covered person: means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan. See Louisiana Revised Statutes 22:2392
• Criminal history record information: means information collected by state or federal criminal justice agencies on individuals consisting of identifiable descriptions and notations of arrests, detentions, indictments, bills of information, or any formal criminal charges, and any disposition arising therefrom, including sentencing, criminal correctional supervision, and release. See Louisiana Revised Statutes 37:2501
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Disclose: means to release, transfer, or otherwise divulge protected health information to any person other than the individual who is the subject of the protected health information. See Louisiana Revised Statutes 22:2392
• Emergency services: means health care items and services furnished or required to evaluate and treat an emergency medical condition. See Louisiana Revised Statutes 22:2392
• Employer: means :

              (a) Any employing unit which in any calendar quarter in either the current or preceding calendar year paid for services in employment wages of one thousand five hundred dollars or more for some portion of a day in each of twenty different calendar weeks, whether or not such weeks were consecutive, in either the current or the preceding calendar year, had in employment at least one individual regardless of whether the same individual was in employment each day. See Louisiana Revised Statutes 23:1472

• Employer: means the state of Louisiana, any city, parish, or other local school board, the State Board of Elementary and Secondary Education, any board created by La. See Louisiana Revised Statutes 11:701
• Employing unit: means any individual or type of organization, including the state of Louisiana or subdivisions, or instrumentality thereof or of any other state or of the United States except as excluded by any other provision of this Chapter, and any partnership, association, trust, estate, joint-stock company, nontrading corporation, insurance company, corporation, or corporate group, whether domestic or foreign, or the receiver, liquidator, trustee in bankruptcy, trustee, or successor thereof, or the legal representative of a deceased person, which has in its employ one or more individuals performing services for it within this state. See Louisiana Revised Statutes 23:1472
• Employment: means , subject to the other provisions of this Subsection, any services including service in interstate commerce, performed for wages or under any contract of hire, written or oral, express or implied;

              B. See Louisiana Revised Statutes 23:1472

• Employment security administration fund: means the employment security administration fund established by this Chapter, from which administrative expenses under this Chapter shall be paid. See Louisiana Revised Statutes 23:1472
• Enrolled bill: The final copy of a bill or joint resolution which has passed both chambers in identical form. It is printed on parchment paper, signed by appropriate officials, and submitted to the President/Governor for signature.
• Evidence-based standard: means the conscientious, explicit, and judicious use of the current best evidence based on the overall systematic review of the research in making decisions about the care of individual patients. See Louisiana Revised Statutes 22:2392
• Ex officio: Literally, by virtue of one's office.
• Executive director: means the director of the Board of Examiners of Nursing Facility Administrators. See Louisiana Revised Statutes 37:2501
• Executor: A male person named in a will to carry out the decedent
• Facility: means an institution providing health care services or a health care setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, rehabilitation and other therapeutic health settings, and inpatient hospice facilities. See Louisiana Revised Statutes 22:2392
• 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.
• FBI: means the Federal Bureau of Investigation of the United States Department of Justice. See Louisiana Revised Statutes 37:2501
• Fiduciary: A trustee, executor, or administrator.
• Final adverse determination: means an adverse determination, including medical judgment, involving a covered benefit that has been upheld by a health insurance issuer, or its designee utilization review organization, at the completion of the health insurance issuer's internal claims and appeals process procedures provided pursuant to La. See Louisiana Revised Statutes 22:2392
• 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.
• Fund: means the unemployment compensation fund established by this Chapter, to which all contributions required and from which all benefits provided under this Chapter shall be paid. See Louisiana Revised Statutes 23:1472
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. ^{Source: Federal Reserve}
• Grievance: means , in a health insurance issuer's internal claims and appeals process, a written complaint or oral complaint, if the complaint involves an urgent care request submitted by or on behalf of a covered person regarding any of the following:

              (a) Availability, delivery, or quality of health care services, including a complaint regarding an adverse determination made pursuant to utilization review. See Louisiana Revised Statutes 22:2392

• Health benefit plan: means a policy, contract, certificate, or agreement entered into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Louisiana Revised Statutes 22:2392
• Health care professional: means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law. See Louisiana Revised Statutes 22:2392
• Health care services: means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:2392
• Health information: means information or data, whether oral or recorded in any form or medium, and personal facts or information about events or relationships that relate to any of the following:

              (a) The past, present, or future physical, mental, or behavioral health or condition of an individual or a member of the individual's family. See Louisiana Revised Statutes 22:2392

• Health insurance issuer: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including through a health benefit plan as defined in this Section, and shall include a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits. See Louisiana Revised Statutes 22:2392
• Hearing aid: means any wearable instrument or device designed for or represented as aiding or compensating for defective human hearing and any parts, attachments, or accessories of such an instrument or device. See Louisiana Revised Statutes 37:2442
• Immediately: means as expeditiously as the medical situation of the covered person requires but in no event longer than one day for expedited reviews or one business day for standard reviews. See Louisiana Revised Statutes 22:2392
• Independent review organization: means an entity that conducts independent external reviews of adverse determinations and final adverse determinations. See Louisiana Revised Statutes 22:2392
• Insured work: means employment for employers. See Louisiana Revised Statutes 23:1472
• 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.
• License: includes a temporary license and a certificate of endorsement. See Louisiana Revised Statutes 37:2442
• Licensure: means any license, permit, certification, or registration that the board is authorized to issue. See Louisiana Revised Statutes 37:2501
• Medical or scientific evidence: means evidence found in the following sources:

              (a) Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff. See Louisiana Revised Statutes 22:2392

• Member: means any teacher included in the membership of the system as provided in Part II of this Chapter. See Louisiana Revised Statutes 11:701
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Nursing facility administrator: means any individual who is or may be charged with the general administration of a nursing facility and who has been licensed and registered by the board in accordance with the provisions of this Chapter. See Louisiana Revised Statutes 37:2501
• 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.
• Person: means an individual, association, partnership, corporation, limited liability company, or other entity. See Louisiana Revised Statutes 23:1761
• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• Practice of nursing facility administration: means the decision-making processes involved in the planning, organizing, staffing, directing, and controlling of operations of a nursing facility whether or not the administrator has an ownership interest in said facility. See Louisiana Revised Statutes 37:2501
• 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.
• Protected health information: means either of the following:

              (a) Health information that identifies an individual who is the subject of the information. See Louisiana Revised Statutes 22:2392

• provider: means a health care professional or a facility. See Louisiana Revised Statutes 22:2392
• Quorum: The number of legislators that must be present to do business.
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Retirement: means withdrawal from active service with a retirement allowance granted under the provisions of this Chapter. See Louisiana Revised Statutes 11:701
• Retrospective review: means a utilization review conducted after services have been provided to a patient, but does not include the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracy of coding, or adjudication for payment. See Louisiana Revised Statutes 22:2392
• Secretary: means the secretary of the commission. See Louisiana Revised Statutes 23:1
• Service of process: The service of writs or summonses to the appropriate party.
• State: includes the states of the United States, the District of Columbia, the Commonwealth of Puerto Rico and the Virgin Islands. See Louisiana Revised Statutes 23:1472
• Summons: Another word for subpoena used by the criminal justice system.
• Temporary nursing facility administrator: means an individual who has not been granted a regular license as a nursing facility administrator, but is issued a temporary license for a specified period of time subject to regulations established by the board. See Louisiana Revised Statutes 37:2501
• Testify: Answer questions in court.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• 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.
• Unethical conduct: includes but is not limited to the following:

              (a) The obtaining of any fee or the making of any sale by fraud or misrepresentation. See Louisiana Revised Statutes 37:2442

• United States: when used in a geographical sense, includes the states, the District of Columbia, the Commonwealth of Puerto Rico, and the Virgin Islands. See Louisiana Revised Statutes 23:1472
• Uphold: The decision of an appellate court not to reverse a lower court decision.
• Utilization review: means a set of formal techniques designed to monitor the use of or evaluate the clinical or medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings. See Louisiana Revised Statutes 22:2392
• Utilization review organization: means a licensed entity that conducts utilization review in the internal claims and appeals process provided pursuant to La. See Louisiana Revised Statutes 22:2392
• Wages: means all remuneration for services, including vacation pay, holiday pay, dismissal pay, commissions, bonuses, the cash value of all remuneration in any medium other than cash, and WARN Act payments received pursuant to 29 U. See Louisiana Revised Statutes 23:1472
• weather modification: as used in this Chapter , means the changing or controlling by chemical, mechanical, or physical methods the occurrence of lightning or the precipitation of rain, hail, mist, sleet, or snow. See Louisiana Revised Statutes 37:2202
• Week: means such period of seven consecutive days, as the administrator may by regulation prescribe. See Louisiana Revised Statutes 23:1472