Terms Used In Tennessee Code > Title 33 > Chapter 2 > Part 7 - Community Mental Health Center Cooperation Act

• Abuse: means the occurrence of one (1) or more of the following acts:
  (A) Attempting to cause or intentionally, knowingly or recklessly causing another person, including a minor child, bodily injury, physical harm, severe emotional distress, psychological trauma, rape, sexual assault or involuntary sexual intercourse. See Tennessee Code 56-8-202
• Abuse status: means the fact or perception that a person is, has been, or may be a subject of abuse, regardless of whether the person has sustained abuse-related medical conditions or has incurred abuse-related claims. See Tennessee Code 56-8-202
• Abuse-related medical condition: means a medical condition sustained by a subject of abuse that arises in whole or part out of an act or pattern of abuse. See Tennessee Code 56-8-202
• Account owner: means the owner of a retained asset account who is a resident of this state. See Tennessee Code 56-7-3403
• Additional business day: means the first weekday not designated as a state or federal holiday. See Tennessee Code 56-7-3702
• 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.
• Annuity: means any active annuity contract issued in this state other than an annuity used to fund an employment-based retirement plan or program where the insurer is not committed by terms of the annuity contract to pay death benefits to the beneficiaries of specific plan participants or that is used to fund a pre-need funeral contract as defined in §. See Tennessee Code 56-7-3403
• 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.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Asymmetric conduct: means an insurer's use of the DMF prior to July 1, 2015, in connection with searching for information regarding whether annuitants under the insurer's annuities might be deceased, but not in connection with whether the insureds under its policies might be deceased. See Tennessee Code 56-7-3403
• 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}
• Beneficiary: means an individual or other entity entitled to benefits under a policy or annuity. See Tennessee Code 56-7-3403
• Chambers: A judge's office.
• Child: means a biological, adopted, or foster son or daughter. See Tennessee Code 56-7-3603
• Chronic condition: means a condition that has an expected duration of one (1) year or more and requires ongoing medical attention or limits activities of daily living, or both. See Tennessee Code 56-7-3702
• Code: includes the Tennessee Code and all amendments and revisions to the code and all additions and supplements to the code. See Tennessee Code 1-3-105
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-9-103
• Commissioner: means the commissioner of mental health and substance abuse services. See Tennessee Code 33-1-101
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-1-102
• commodity contract: means :
  (i) A contract for the purchase or sale of a commodity for future delivery on, or subject to the rules of, a board of trade or contract market under the Commodity Exchange Act ( 7 U. See Tennessee Code 56-9-103
• 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 mental health center: includes any parent or corporate affiliate of a community mental health center as defined in §. See Tennessee Code 33-2-703
• 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.
• Cooperative agreement: means an agreement among two (2) or more community mental health centers for the offering, provision, operation, coordination, planning, funding, pricing, contracting, utilization review, or management of mental health and related services under programs funded or administered by departments or agencies of state government, including, but not limited to, the TennCare program, or the sharing, allocation, or referral of service recipients, personnel, instructional programs, support services, ancillary services, and facilities, or other services traditionally offered by community mental health centers for the programs. See Tennessee Code 33-2-703
• 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.
• Deed: The legal instrument used to transfer title in real property from one person to another.
• Delinquency proceeding: means any proceeding instituted against an insurer for the purpose of liquidating, rehabilitating, reorganizing or conserving the insurer, and any summary proceeding under §. See Tennessee Code 56-9-103
• Department: means the department of mental health and substance abuse services. See Tennessee Code 33-1-101
• Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
• Dependent: A person dependent for support upon another.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• DMF: means the death master file from the United States social security administration or any other database or service that an insurer may determine is substantially as inclusive as the death master file for determining that a person has reportedly died. See Tennessee Code 56-7-3403
• DMF match: means a search of a DMF that results in a match of a person's social security number or name and date of birth. See Tennessee Code 56-7-3403
• Domiciliary state: means the state in which an insurer is incorporated or organized, or, in the case of an alien insurer, its state of entry. See Tennessee Code 56-9-103
• Emergency healthcare services: means emergency services as defined in §. See Tennessee Code 56-7-3702
• Employee: means an individual for whom an employer must complete a Form I-9 pursuant to federal law and regulations, and does not include an independent contractor. See Tennessee Code 56-7-3603
• 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}
• Escheat: Reversion of real or personal property to the state when 1) a person dies without leaving a will and has no heirs, or 2) when the property (such as a bank account) has been inactive for a certain period of time. ^{Source: OCC}
• 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 an institution licensed under title 33 or 68. See Tennessee Code 56-7-3702
• Family leave insurance: means an insurance policy issued to an employer related to a benefit program provided to an employee to pay for a percentage or portion of the employee's income loss due to:
  (A) The birth or adoption of a child by the employee. See Tennessee Code 56-7-3603
• Family member: means :
  (A) A child, spouse, or parent. See Tennessee Code 56-7-3603
• Federal home loan bank: means an institution chartered under the Federal Home Loan Bank Act ( 12 U. See Tennessee Code 56-9-103
• Federal Reserve System: The central bank of the United States. The Fed, as it is commonly called, regulates the U.S. monetary and financial system. The Federal Reserve System is composed of a central governmental agency in Washington, D.C. (the Board of Governors) and twelve regional Federal Reserve Banks in major cities throughout the United States. ^{Source: OCC}
• Foreign: when used without limitation, includes all companies formed by authority of any other state or government. See Tennessee Code 56-1-102
• general assets: includes all the property or its proceeds in excess of the amount necessary to discharge the sum or sums secured thereby. See Tennessee Code 56-9-103
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Guaranty association: means the Tennessee insurance guaranty association created by chapter 12, part 1 of this title, the life and health insurance guaranty association created by chapter 12, part 2 of this title, and any other similar entity now or hereafter created by the general assembly of this state for the payment of claims of insolvent insurers. See Tennessee Code 56-9-103
• Health benefit plan: includes accident only, credit health, dental, vision, medicare supplement, or long-term care coverage issued as a supplement to liability insurance, automobile medical payment insurance, short-term and catastrophic health insurance policies, and a policy that pays on a cost-incurred basis. See Tennessee Code 56-8-202
• Health carrier: 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 cost of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or health services. See Tennessee Code 56-8-202
• Healthcare service: means a service rendered by a healthcare provider or at a practice that provides testing, monitoring, diagnosis, or treatment of a human disease or condition, or dispenses medical devices, medical appliances, or medical goods for the treatment of a human disease or condition. See Tennessee Code 56-7-3702
• Hospital: means a public or private hospital or facility or part of a hospital or facility equipped to provide inpatient care and treatment for persons with mental illness or serious emotional disturbance. See Tennessee Code 33-1-101
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• insolvent: means :
  (A) For an insurer issuing only assessable fire insurance policies:

  (i) The inability to pay any obligation within thirty (30) days after it becomes payable. See Tennessee Code 56-9-103
• insured: includes a person who is a beneficiary covered by a group policy, certificate, or health benefit plan. See Tennessee Code 56-8-202
• Insurer: means any person who has done, purports to do, is doing or is licensed to do an insurance business, and is or has been subject to the authority of, or to liquidation, rehabilitation, reorganization, supervision, or conservation by, any insurance commissioner. See Tennessee Code 56-9-103
• Insurer: means any insurance company authorized to transact life insurance business in this state. See Tennessee Code 56-7-3403
• Interchangeable biological product: means a biological product licensed by the federal food and drug administration and determined to meet the safety standards for determining interchangeability pursuant to 42 U. See Tennessee Code 56-7-3501
• Intervenor: means any hospital, physician, allied health professional, health care provider or other person furnishing goods or services to, or in competition with, community mental health center, insurer, hospital service corporation, medical service corporation, hospital and medical services corporation, preferred provider organization, health maintenance organization, behavioral health organization, or any employer or association that directly or indirectly provides health care benefits to its employees or members. See Tennessee Code 33-2-703
• 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.
• liabilities: include , but are not limited to, reserves required by statute or by department general regulations or specific requirements imposed by the commissioner upon a subject company at the time of admission or subsequent thereto. See Tennessee Code 56-9-103
• 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.
• Mental illness: means a psychiatric disorder, alcohol dependence, or drug dependence, but does not include intellectual disability or other developmental disabilities as defined in title 52. See Tennessee Code 33-1-101
• Minor: means any person who has not attained eighteen (18) years of age. See Tennessee Code 1-3-105
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Mortgagor: The person who pledges property to a creditor as collateral for a loan and who receives the money.
• Netting agreement: means :
  (A) A contract or agreement, including terms and conditions incorporated by reference in it, including a master agreement, which master agreement, together with all schedules, confirmations, definitions, and addenda to it and transactions under any of them, shall be treated as one (1) netting agreement, that documents one (1) or more transactions between the parties to the agreement for or involving one (1) or more qualified financial contracts and that provides for the netting, liquidation, setoff, termination, acceleration, or close-out, under or in connection with one (1) or more qualified financial contracts or present or future payment or delivery obligations or payment or delivery entitlements under one (1) or more qualified financial contracts, including liquidation or close-out values relating to those obligations or entitlements, among the parties to the netting agreement. See Tennessee Code 56-9-103
• 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: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
• Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds-type organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Tennessee Code 56-16-102
• Person: means the policy insured, annuity owner, annuitant, or account owner, as applicable under the policy, annuity, or retained asset account subject to this part. See Tennessee Code 56-7-3403
• Physician: means a medical doctor or osteopathic physician with a valid state medical license issued pursuant to title 63, chapter 6 or 9. See Tennessee Code 56-7-3702
• plan: means a policy, contract, certificate or agreement offered by a carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. See Tennessee Code 56-8-202
• Policy: means a contract of insurance, certificate, indemnity, suretyship, or annuity issued, proposed for issuance, or intended for issuance by an insurer, including endorsements or riders to an insurance policy or contract. See Tennessee Code 56-8-202
• Policy: means any policy or certificate of life insurance issued in this state, but does not include any policy or certificate of life insurance that provides a death benefit under:
  (A) An employee benefit plan subject to the Employee Retirement Income Security Act of 1974, as periodically amended, compiled at 29 U. See Tennessee Code 56-7-3403
• Practice: means an entity formed with at least one (1) healthcare provider to provide healthcare services. See Tennessee Code 56-7-3702
• 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.
• Prescription drug: means a drug that under federal or state law is required to be dispensed only pursuant to a prescription order or is restricted to use by individuals authorized by law to prescribe drugs. See Tennessee Code 56-7-3501
• Prior authorization: means a written or oral determination made by a health carrier or utilization review organization, or an agent of such carrier or organization, that an enrollee's receipt of a healthcare service is a covered benefit under the applicable plan and that a requirement of medical necessity or other requirements imposed by such utilization review organization as prerequisites for payment for such services have been satisfied. See Tennessee Code 56-7-3702
• Property: includes both personal and real property. See Tennessee Code 1-3-105
• provider: means any person or entity performing services regulated pursuant to title 63 or title 68, chapter 11, with whom the health insurance entity has an express and valid network provider agreement or contract. See Tennessee Code 56-7-3301
• Qualified financial contract: means any commodity contract, forward contract, repurchase agreement, securities contract, swap agreement, and any similar agreement that the commissioner determines to be a qualified financial contract for the purposes of this chapter. See Tennessee Code 56-9-103
• Reasonably accurate: means information determined through application by the health insurance entity of contract rates, fee schedules and reimbursement rules and policies in effect as of the date inquiry is made by the provider. See Tennessee Code 56-7-3301
• Receiver: means receiver, liquidator, rehabilitator or conservator as the context requires. See Tennessee Code 56-9-103
• Reciprocal: means the aggregation of subscribers under a common name. See Tennessee Code 56-16-102
• Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
• Record keeping services: means those circumstances under which the insurer has agreed with a group life insurance policyholder to be responsible for obtaining, maintaining, and administering in its own systems information about each individual insured under the policyholder's group life insurance contract at least the following information:
  (A) Individual insured's social security number or name and date of birth. See Tennessee Code 56-7-3403
• 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.
• Reporter: Makes a record of court proceedings and prepares a transcript, and also publishes the court's opinions or decisions (in the courts of appeals).
• Required prescription drug: means a medication that is required as part of a step therapy protocol. See Tennessee Code 56-7-3501
• Savings and loan association: includes a building and loan association, a federal or state savings and loan association, a federal savings bank, and any other financial institution, the accounts of which are insured by the [former] federal savings and loan insurance corporation (FSLIC) or any successor [repealed] of such corporation. See Tennessee Code 1-3-105
• Serious emotional disturbance: means a condition in a child who currently or at any time during the past year has had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet psychiatric diagnostic criteria that results in functional impairment that substantially interferes with or limits the child's role or functioning in family, school, or community activities and includes any mental disorder, regardless of whether it is of biological etiology. See Tennessee Code 33-1-101
• Serious health condition: means an illness, injury, impairment, or physical or mental condition, including transplantation preparation and recovery from surgery related to organ or tissue donation, that involves inpatient care in a hospital, hospice, or residential healthcare facility, continuing treatment or continuing supervision by a healthcare provider as defined in an insurance policy issued under this part. See Tennessee Code 56-7-3603
• Service member: means a member of the United States armed forces in active military service. See Tennessee Code 56-7-3603
• 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.
• sex: means a person's immutable biological sex as determined by anatomy and genetics existing at the time of birth and evidence of a person's biological sex. See Tennessee Code 1-3-105
• signed: includes a mark, the name being written near the mark and witnessed, or any other symbol or methodology executed or adopted by a party with intention to authenticate a writing or record, regardless of being witnessed. See Tennessee Code 1-3-105
• State: means any state, district or territory of the United States and the Panama Canal Zone. See Tennessee Code 56-9-103
• State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
• Statute: A law passed by a legislature.
• Step therapy protocol: means a protocol, policy, or program that establishes a specific sequence in which prescription drugs for a specified medical condition, and medically appropriate for a particular patient, are covered by a health carrier or health benefit plan. See Tennessee Code 56-7-3501
• Subject of abuse: means a person to whom a family member, or a current or former household member, intimate partner, or caretaker, or a perpetrator of sexual assault, a stalker or a sex offender has directed an act as defined in subdivision (1). See Tennessee Code 56-8-202
• Subpoena: A command to a witness to appear and give testimony.
• Support: means any activity or resource that enables a service recipient to participate in a service for mental illness or serious emotional disturbance or in community life. See Tennessee Code 33-1-101
• Testify: Answer questions in court.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Transfer: includes the sale and every other and different mode, direct or indirect, of disposing of or of parting with property or with an interest therein, or with the possession thereof or of fixing a lien upon property or upon an interest therein, absolutely or conditionally, voluntarily, by or without judicial proceedings. See Tennessee Code 56-9-103
• 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.
• United States: includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
• Utilization review organization: means :
  (A) A health carrier or other entity, including a designee of such carrier or entity, that reviews or issues prior authorizations for a health carrier. See Tennessee Code 56-7-3702
• Utilization review organization: means an entity that conducts utilization review, as defined in §. See Tennessee Code 56-7-3501
• written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
• Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105