Terms Used In Maine Revised Statutes > Title 24-A > Chapter 56 - Health Maintenance Organizations

• Adoption assistance state: means the State that is signatory to an adoption assistance agreement in a particular case. See Maine Revised Statutes Title 22 Sec. 4172
• Adult: means a person who has attained the age of 18 years. See Maine Revised Statutes Title 1 Sec. 72
• 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.
• Allegation: something that someone says happened.
• 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.
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• 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.
• Approved placement: means the receiving state has determined after an assessment that the placement is both safe and suitable for the child and is in compliance with the applicable laws of the receiving state governing the placement of children in the receiving state. See Maine Revised Statutes Title 22 Sec. 4252
• Assessment: means an evaluation of a prospective placement to determine whether the placement meets the individualized needs of the child, including but not limited to the child's safety and stability, health and well-being and mental, emotional and physical development. See Maine Revised Statutes Title 22 Sec. 4252
• Assistance unit: means the individuals whose need the department considers when determining whether an applicant or recipient is eligible for program benefits. See Maine Revised Statutes Title 22 Sec. 3811
• At risk: means , with regard to a person, that the person is a member of an economically disadvantaged family, a recipient or former recipient of services under the child protection or child welfare system of the State, in foster care, homeless, a member of a family exposed to substance use disorder, identified as having special needs, identified as having a physical or mental disability or identified as having limited English proficiency. See Maine Revised Statutes Title 22 Sec. 3931
• Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
• Attorney-in-fact: A person who, acting as an agent, is given written authorization by another person to transact business for him (her) out of court.
• Bail: Security given for the release of a criminal defendant or witness from legal custody (usually in the form of money) to secure his/her appearance on the day and time appointed.
• 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 health care services: means health care services that an enrolled population might reasonably require in order to be maintained in good health and includes, at a minimum, emergency care, inpatient hospital care, inpatient physician services, outpatient physician services, ancillary services such as x-ray services and laboratory services and all benefits mandated by statute and mandated by rule applicable to health maintenance organizations. See Maine Revised Statutes Title 24-A Sec. 4202-A
• Basic necessities: means food, potable water, clothing, shelter, fuel, electricity, nonelective medical services as recommended by a physician, nonprescription drugs, telephone where it is necessary for medical reasons and any other commodity or service determined essential by the overseer in accordance with the municipality's ordinance and this chapter. See Maine Revised Statutes Title 22 Sec. 4301
• Board: means the Board of the Maine Children's Trust Incorporated. See Maine Revised Statutes Title 22 Sec. 3881
• Capitated basis: means fixed per-member, per-month payments or percentage-of-premium payments pursuant to which the provider assumes full risk for the cost of contracted services without regard to the type, value or frequency of services provided. See Maine Revised Statutes Title 24-A Sec. 4202-A
• Carrier: means a health maintenance organization, an insurer, a nonprofit hospital, a medical service corporation or any other entity responsible for the payment of benefits or provision of services under a group contract. See Maine Revised Statutes Title 24-A Sec. 4202-A
• Chambers: A judge's office.
• Child: means a person under 6 years of age who has not entered kindergarten. See Maine Revised Statutes Title 22 Sec. 3931
• Child: means an individual who has not attained 18 years of age. See Maine Revised Statutes Title 22 Sec. 4252
• Child abuse and neglect prevention council: means a community organization that provides continuous year-round service as a county's primary organization that serves to encourage and coordinate community efforts to prevent child abuse from occurring. See Maine Revised Statutes Title 22 Sec. 3872
• 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.
• Commissioner: means the Commissioner of Health and Human Services. See Maine Revised Statutes Title 22 Sec. 1-A
• 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.
• Community: means a geographical area represented by a community coalition and served or to be served by a project. See Maine Revised Statutes Title 22 Sec. 3931
• Community coach: means an employee of or contractor with a community contractor who is trained under subsection 11 and performs administrative functions in carrying out the duties of a project. See Maine Revised Statutes Title 22 Sec. 3931
• Community coalition: means a group of stakeholders, service providers or other members within a community under subsection 7 that sponsors and collaborates in the implementation and administration of a project. See Maine Revised Statutes Title 22 Sec. 3931
• Community contractor: means a nonprofit organization that is the applicant and responsible lead member of a community coalition for a project. See Maine Revised Statutes Title 22 Sec. 3931
• Community provider: means a child care center, family child care provider or other service provider that has entered into a contract with a community contractor to provide services as part of a project. See Maine Revised Statutes Title 22 Sec. 3931
• 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.
• Copayment: means an amount an enrollee must pay in order to receive a specific service that is not fully prepaid. See Maine Revised Statutes Title 24-A Sec. 4202-A
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Deductible: means the amount an enrollee is responsible to pay out of pocket before a health maintenance organization begins to pay the costs associated with treatment. See Maine Revised Statutes Title 24-A Sec. 4202-A
• Deed: The legal instrument used to transfer title in real property from one person to another.
• Default: means the failure of a member state to perform the obligations or responsibilities imposed upon it by this chapter or the bylaws or rules of the interstate commission. See Maine Revised Statutes Title 22 Sec. 4252
• Department: means the Department of Health and Human Services. See Maine Revised Statutes Title 22 Sec. 1-A
• 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.
• Direct costs: means the total value of general assistance benefits paid out by a municipality that is in compliance with this chapter and the municipality's general assistance ordinance. See Maine Revised Statutes Title 22 Sec. 4301
• 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:
• Docket: A log containing brief entries of court proceedings.
• Domestic partner: means one of 2 unmarried adults who are domiciled together under long-term arrangements that evidence a commitment to remain responsible indefinitely for each other's welfare. See Maine Revised Statutes Title 1 Sec. 72
• Donor: The person who makes a gift.
• Dwelling unit: means a building or part thereof used for separate living quarters for one or more persons living as a single housekeeping unit. See Maine Revised Statutes Title 22 Sec. 4301
• Economically disadvantaged: means having a family income not exceeding 185% of the federal poverty level as defined in section 3762, subsection 1, paragraph C. See Maine Revised Statutes Title 22 Sec. 3931
• Eligible organization: means a nonprofit organization, local government or public school system. See Maine Revised Statutes Title 22 Sec. 3881
• Eligible person: means a person who is qualified to receive general assistance from a municipality according to standards of eligibility determined by the municipal officers whether or not that person has applied for general assistance. See Maine Revised Statutes Title 22 Sec. 4301
• Embedded professional development: means an activity performed by a community coach to encourage rule-specific knowledge, skills and dispositions to support responsive caregiving and developmentally appropriate teaching practices implemented for learning that is integrated into the work day, consists of assessing and finding solutions for authentic and immediate problems of practice as part of a cycle of continuous improvement and is grounded in day-to-day teaching practice designed to enhance a teacher's or caregiver's practices with the intent of improving children's social, emotional and cognitive development. See Maine Revised Statutes Title 22 Sec. 3931
• Emergency: means any life threatening situation or a situation beyond the control of the individual which, if not alleviated immediately, could reasonably be expected to pose a threat to the health or safety of a person. See Maine Revised Statutes Title 22 Sec. 4301
• emergency purposes: means any situation in which no other permanent lodging is available unless a security deposit is paid. See Maine Revised Statutes Title 22 Sec. 4301
• Enrollee: means an individual who is enrolled in a health maintenance organization. See Maine Revised Statutes Title 24-A Sec. 4202-A
• 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.
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• Evidence of coverage: means any certificate, agreement or contract issued to a group contract holder or an enrollee setting out the coverage to which an enrollee is entitled. See Maine Revised Statutes Title 24-A Sec. 4202-A
• Ex officio: Literally, by virtue of one's office.
• 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.
• Family: means a child, the child's parent and all people living in the household of the child who are supported by the income of the child's parent and related to the child or child's parent by blood, marriage or adoption. See Maine Revised Statutes Title 22 Sec. 3931
• federal Affordable Care Act: means the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any amendments to or regulations or guidance issued under those acts. See Maine Revised Statutes Title 24-A Sec. 14
• Fiduciary: A trustee, executor, or administrator.
• Fiscal agent: means an incorporated community organization, agency or institution designated by the child abuse and neglect prevention council and authorized by the Department of Health and Human Services to receive and distribute grants to that child abuse and neglect prevention council. See Maine Revised Statutes Title 22 Sec. 3872
• 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}
• Foreign jurisdiction: means a state other than this State. See Maine Revised Statutes Title 14 Sec. 402
• Foreign subpoena: means a subpoena issued under authority of a court of record of a foreign jurisdiction. See Maine Revised Statutes Title 14 Sec. 402
• Fraud: Intentional deception resulting in injury to another.
• Fund: means the repository for funds donated to the Maine Children's Trust Incorporated by the taxpayers of the State through an income tax checkoff pursuant to Title 36, section 5285 as well as federal grants and contracts, privately donated funds and in-kind donations for prevention programs, or by any means for the purposes of this chapter. See Maine Revised Statutes Title 22 Sec. 3881
• General assistance program: means a service administered by a municipality for the immediate aid of persons who are unable to provide the basic necessities essential to maintain themselves or their families. See Maine Revised Statutes Title 22 Sec. 4301
• 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}
• Group contract holder: means an entity or person that has purchased coverage from a health maintenance organization that provides, at a minimum, basic health care services to enrollees. See Maine Revised Statutes Title 24-A Sec. 4202-A
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health care services: means any services included in the furnishing of medical care, dental care or hospitalization to an individual, or any services incident to the furnishing of that care or hospitalization, as well as the furnishing of any other services to an individual to prevent, alleviate, cure or heal human illness or injury. See Maine Revised Statutes Title 24-A Sec. 4202-A
• health insurance: means insurance of human beings against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness, and every insurance appertaining thereto, including provision for the mental and emotional welfare of human beings by defraying the costs of legal services only to the extent provided for in chapter 38. See Maine Revised Statutes Title 24-A Sec. 704
• Health maintenance organization: means a public or private organization that is organized under the laws of the Federal Government, this State, another state or the District of Columbia or a component of such an organization, and that: