§ 9:1721 Title
§ 9:1722 Express private trusts authorized; application of Code
§ 9:1723 Dispositions containing substitutions
§ 9:1724 Construction of Code
§ 9:1725 Except when the context clearly indicates otherwise, as used in this Code:

Terms Used In Louisiana Revised Statutes > Title 9 > CODE TITLE II > Chapter 1 > Part I - Preliminary Provisions

  • 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

  • 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.
  • Ambulatory review: means utilization review of health care services performed or provided in an outpatient setting. See Louisiana Revised Statutes 22:2392
  • 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: shall mean any person seeking to practice engineering or land surveying in the state of Louisiana, that has applied to the board for authority to practice the respective profession and render such engineering or land surveying services in the state of Louisiana, or an individual who has applied to the board for certification as an engineer intern or land surveyor intern. See Louisiana Revised Statutes 37:682
  • Appraisal: A determination of property value.
  • 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

  • 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
  • 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
  • Best evidence: means evidence based on any of the following:

                (a) Randomized clinical trials. See Louisiana Revised Statutes 22:2392

  • Board: means the Board of Trustees of the Louisiana State Employees' Retirement System. See Louisiana Revised Statutes 11:403
  • Board: means the Louisiana State Board of Medical Examiners. See Louisiana Revised Statutes 37:611
  • Board: shall mean the Louisiana Professional Engineering and Land Surveying Board, provided for by this Chapter. See Louisiana Revised Statutes 37:682
  • Board: means the Louisiana Board of Professional Geoscientists, provided for by this Chapter. See Louisiana Revised Statutes 37:711.2
  • Business day: means a day of normal business operation other than federally recognized holidays. See Louisiana Revised Statutes 22:2392
  • Case management: means a coordinated set of activities conducted for individual patient management of serious, complicated, protracted, or other health conditions. See Louisiana Revised Statutes 22:2392
  • Case-series: means an evaluation of a series of patients with a particular outcome, without the use of a control group. See Louisiana Revised Statutes 22:2392
  • certificate holder: shall mean the recognition granted by the board and its issuance of acertificate to any individual seeking such recognition as an engineer intern or land surveyor intern, who has been successfully examined and is otherwise in good standing with the board. See Louisiana Revised Statutes 37:682
  • Chambers: A judge's office.
  • 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
  • Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:2392
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Concurrent review: means utilization review conducted during a patient's stay or course of treatment in a facility, the office of a health care professional, or other inpatient or outpatient health care setting. See Louisiana Revised Statutes 22:2392
  • 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.
  • Covered person: means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan. See Louisiana Revised Statutes 22:2392
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • Discharge planning: means the formal process for determining, prior to discharge from a facility, the coordination and management of the care that a patient receives following discharge from a facility. See Louisiana Revised Statutes 22:2392
  • 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 medical condition: means a medical condition manifesting itself by symptoms of sufficient severity, including severe pain, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect that the absence of immediate medical attention would result in serious impairment to bodily functions, serious dysfunction of a bodily organ or part, or would place the person's health or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy. 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
  • Employee: means any person legally occupying a position in the state service. See Louisiana Revised Statutes 11:403
  • Employer: means the state of Louisiana or any of its boards, commissions, departments, agencies, and courts which are contributing members of the Louisiana State Employees' Retirement System. See Louisiana Revised Statutes 11:403
  • Engineer intern: shall mean an individual who has complied with the requirements for education, experience, and character and has passed an examination in the fundamental engineering subjects, as provided in this Chapter, and has been issued a certificate by the board. See Louisiana Revised Statutes 37:682
  • entity: means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing. See Louisiana Revised Statutes 22:2392
  • 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.
  • 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
  • Expert opinion: means a belief or an interpretation by specialists with experience in a specific area about the scientific evidence pertaining to a particular service, intervention, or therapy. See Louisiana Revised Statutes 22:2392
  • 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
  • Felony: A crime carrying a penalty of more than a year in prison.
  • 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 R. See Louisiana Revised Statutes 22:2392
  • Firm: shall mean any domestic or foreign firm, partnership, association, cooperative, venture, corporation, limited liability company, limited liability partnership, or any other entity. See Louisiana Revised Statutes 37:682
  • 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.
  • Geoscience: means the science of the earth and its origin and history, the investigation of the earth's environment and its constituent soils, rocks, minerals, solids, and fluids, and the study of the natural and introduced agents, forces, and processes that cause changes in and on the earth. See Louisiana Revised Statutes 37:711.2
  • Geoscientist: means a person qualified to engage in the practice of geoscience because of the person's knowledge, acquired through education and practical experience, of geoscience, mathematics, and the supporting physical, chemical, mineralogical, morphological, and life sciences. See Louisiana Revised Statutes 37:711.2
  • Geoscientist in training: means a person registered by the board on the basis of education and who meets other requirements established by the board but who is not fully qualified to be a licensed geoscientist under this Chapter. See Louisiana Revised Statutes 37:711.2
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • 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
  • 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
  • Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
  • 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.
  • Land surveyor intern: shall mean an individual who has complied with the requirements for education, experience, and character and has passed an examination in the fundamental surveying subjects, as provided in this Chapter, and has been issued a certificate by the board. See Louisiana Revised Statutes 37:682
  • licensed water well driller: means a person, firm, or corporation licensed to drill a water well, as set forth in R. See Louisiana Revised Statutes 37:711.2
  • Licensee: shall mean any person practicing or seeking to practice engineering or land surveying in the state of Louisiana that has received a license from the board and is otherwise in good standing with the board. See Louisiana Revised Statutes 37:682
  • licensure: shall mean the recognition granted by the board and its issuance of a license to any person to practice engineering or land surveying in the state of Louisiana. See Louisiana Revised Statutes 37:682
  • licensure: means the recognition granted by the board and its issuance of a license to any person to practice geoscience in the state of Louisiana. See Louisiana Revised Statutes 37:711.2
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • 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 person included in the membership of the system. See Louisiana Revised Statutes 11:403
  • Minor child: means an unmarried child under the age of eighteen years or an unmarried student under the age of twenty-three years who is the issue of a marriage of a member of this system, the legally adopted child of a member of this system, a child born outside of marriage of a female member of this system, or the child of a male member of this system if acknowledged or filiated pursuant to the provisions of the Civil Code. See Louisiana Revised Statutes 11:403
  • Misdemeanor: Usually a petty offense, a less serious crime than a felony, punishable by less than a year of confinement.
  • 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.
  • 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: shall mean any individual or firm. See Louisiana Revised Statutes 37:682
  • Person: means any individual. See Louisiana Revised Statutes 37:711.2
  • Personal property: All property that is not real property.
  • 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.
  • Position: means any office or any employment in the state service. See Louisiana Revised Statutes 11:403
  • Practice of engineering: shall mean responsible professional service which may include consultation, investigation, evaluation, planning, designing, or inspection of construction in connection with any public or private utilities, structures, machines, equipment, processes, works, or projects wherein the public welfare or the safeguarding of life, health, and property is concerned or involved, when such professional service requires the application of engineering principles and the interpretation of engineering data. See Louisiana Revised Statutes 37:682
  • Practice of engineering: means responsible professional service which may include consultation, investigation, evaluation, planning, designing, or inspection of construction in connection with any public or private utilities, structures, machines, equipment, processes, works, or projects wherein the public welfare or the safeguarding of life, health, and property is concerned or involved, when such professional service requires the application of engineering principles and the interpretation of engineering data. See Louisiana Revised Statutes 37:711.2
  • Practice of geoscience: means the practice for the public of geoscientific services or work, including consulting, investigating, evaluating, analyzing, planning, mapping, and inspecting geoscientific work and the responsible supervision of those tasks. See Louisiana Revised Statutes 37:711.2
  • Practice of land surveying: shall include the measuring of areas, land surfaces, streams, bodies of water, and swamps for correct determination and description, for the establishment, reestablishment, ascertainment, or description of land boundaries, corners, divisions, distances, and directions, the plotting and monumenting of lands and subdivisions thereof, and mapping and topographical work. See Louisiana Revised Statutes 37:682
  • Practice of land surveying: includes the measuring of areas, land surfaces, streams, bodies of water, and swamps for correct determination and description, for the establishment, reestablishment, ascertainment, or description of land boundaries, corners, divisions, distances, and directions, the plotting and monumenting of lands and subdivisions thereof, and mapping and topographical work. See Louisiana Revised Statutes 37:711.2
  • 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.
  • Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
  • professional engineer: shall mean an individual who, by reason of his special knowledge and ability to apply the mathematical, physical, and engineering sciences and the principles and methods of engineering analysis and design, acquired by an engineering education and engineering experience, is qualified to practice engineering, as evidenced by his licensure as such by the board. See Louisiana Revised Statutes 37:682
  • professional engineer: means an individual who, by reason of his special knowledge and ability to apply the mathematical, physical, and engineering sciences and the principles and methods of engineering analysis and design, acquired by an engineering education and engineering experience, is qualified to practice engineering, as evidenced by his licensure as such by the Louisiana Professional Engineering and Land Surveying Board, as set forth in Chapter 8 of this Title. See Louisiana Revised Statutes 37:711.2
  • professional land surveyor: shall mean an individual who is qualified to practice land surveying, as evidenced by his licensure as such by the board. See Louisiana Revised Statutes 37:682
  • Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
  • Prospective review: means utilization review conducted prior to an admission or the provision of a health care service or a course of treatment in accordance with a health insurance issuer's requirement that the health care service or course of treatment, in whole or in part, be approved prior to its provision. See Louisiana Revised Statutes 22:2392
  • 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.
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • 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.
  • Rescission: means cancellation or discontinuance of coverage under a health benefit plan that has a retroactive effect. See Louisiana Revised Statutes 22:2392
  • 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.
  • Responsible charge: shall mean the direct control and personal supervision of engineering or land surveying service or work, as the case may be. See Louisiana Revised Statutes 37:682
  • Responsible charge: means the independent control and direction of geoscientific work or the supervision of geoscientific work by the use of initiative, skill, and independent judgment. See Louisiana Revised Statutes 37:711.2
  • Retirement: means termination of active service, with a retirement allowance granted under the provisions of this Chapter. See Louisiana Revised Statutes 11:403
  • 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
  • Second opinion: means an opportunity or requirement to obtain a clinical evaluation by a provider other than the one originally making a recommendation for a proposed health care service to assess the clinical or medical necessity and appropriateness of the initial proposed health care service. See Louisiana Revised Statutes 22:2392
  • 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.
  • Spouse: means a person who is legally married to a member of this system. See Louisiana Revised Statutes 11:403
  • State: means the state of Louisiana. See Louisiana Revised Statutes 11:403
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • Summons: Another word for subpoena used by the criminal justice system.
  • System: means the Louisiana State Employees' Retirement System. See Louisiana Revised Statutes 11:403
  • 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.
  • Uphold: The decision of an appellate court not to reverse a lower court decision.
  • Urgent care request: means :

                (a) A request for a health care service or course of treatment with respect to which the time periods for making a non-urgent care request determination either:

                (i) Could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function. See Louisiana Revised Statutes 22:2392

  • 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 R. See Louisiana Revised Statutes 22:2392
  • Writ: A formal written command, issued from the court, requiring the performance of a specific act.
  • Writ of certiorari: An order issued by the Supreme Court directing the lower court to transmit records for a case for which it will hear on appeal.