(a) For the purposes of this Part, the following terms shall have the following meanings:

1. (1) A finding of appropriateness means a finding that a hospital service or home care service substantially meets the criteria set forth in this Part.

2. (2) Areawide review means the review of a specific hospital service or home care service as delivered by all providers of such service in a health service area of the State which:

   1. (i) shall culminate in findings regarding the appropriateness of what service over the entire health service area or the State; and
   2. (ii) may result in institution-specific findings.
3. (3) Areawide finding means a finding regarding the appropriateness of a specific hospital service or home care service as delivered by all providers of such service in a health service area or the State which is based on the areawide review of the service in accordance with the criteria set forth in this Part.
4. (4) Institution-specific finding means a finding regarding the appropriateness of a specific hospital service or home care service as delivered by a specific provider which is based on the areawide review of the service in accordance with the criteria set forth in this Part.

5. (5) Hospital service means a health service which:

   1. (i) is provided by a hospital or other provider as defined in article 28 of the Public Health Law, including hospital services and health-related services as define therein; and
   2. (ii) is offered at the time of review for appropriateness, or was offered in the 12 months prior to the review and also will be offered in the 12 months following the review, or which will be offered during the 12 months following the review.

6. (6) Home care service means a home care service as defined in article 36 of the Public Health Law which:

   1. (i) is provided by a certified home health agency as defined in article 36 of the Public Health Law; and
   2. (ii) is offered at the time of the review for appropriateness, or was offered in the 12 months prior to the review and also will be offered in the 12 months following the review, or which will be offered during the 12 months following the review.
7. (7) Affected persons include: the persons or entities whose service is being reviewed; the State Health Planning and Development Agency having jurisdiction; the health systems agency for the health service area in which the service is offered; health systems agencies serving contiguous health service areas; other hospitals and certified home health agencies within the health service area; any agency which establishes rates for hospitals or certified home health agencies; and members of the public who regularly use the service being reviewed.
8. (8) State Health Plan means the plan required to be developed by the State Health Planning and Development Agency and the Statewide Health Coordinating Council pursuant to the provisions of the National Health Planning and Resources Development Act of 1974, Public Law 93-641, as amended.

(b) The services subject to review are defined as follows:

1. (i) Burn care services is that care provided to burn patients in a facility having the capability, equipment and personnel to provide those highly skilled treatment measures required by such victims. Three degrees of severity of burn injury are identified to define the level of treatment:

   1. (a) Major burn injury is at least a second degree burn requiring hospitalization of the patient whose chances of survival are less than 95 percent or whose injury frequently results in disability. A 95 percent chance of survival can generally be described as a second degree burn of greater than 25 percent total body surface area (TBSA) in persons between the ages of 15 and 35 years, and greater than 20 percent TBSA in children younger than 15 years and adults between 35 and 60 years of age, and all burns involving poor-risk patients, that is anyone older than 60 years and anyone with a positive history of chronic and severe illness. Also included in this category are all third degree burns of 10 percent TBSA or greater, all burns significantly involving the hands, face, eyes, ears, feet or perineum, all circumferential burns, all serious inhalation injuries, and all electrical burns and complicated burn injuries involving fractures or other major trauma.
   2. (b) Moderate uncomplicated burn injury is a burn injury requiring hospitalization and generally described as a second degree burn of less than 25 percent TBSA but more than 15 percent in persons between the ages of 15 and 35 years, and between 10 percent and 20 percent in children younger than 15 years and in adults between 35 and 60 years of age, and a third degree burn of less than 10 TBSA but more than 2 percent. Excluded from this category are all poor-risk patients, that is, anyone older than 60 years and anyone with a positive history of chronic and severe illness, all burns significantly involving the eyes, ears, face, hands, feet or perineum, all circumferential burns, all serious inhalation injuries, and all electrical burns and complicated burn injuries involving fractures or other major trauma.
   3. (c) Minor burn injury is a second degree burn of less than 15 percent TBSA in persons between the ages of 15 and 35, and less than 10 percent TBSA in children younger than 15 years and in adults between 35 and 60 years of age, and a third degree burn of less than two percent. Excluded from this category are all poor-risk patients, that is, anyone older than 60 years and anyone with a positive history of chronic and severe illness, all burns significantly involving the eyes, ears, face, hands, feet or perineum, all circumferential burns, all serious inhalation injuries, and all electrical burns and complicated burn injuries involving fractures or other major trauma.

2. (ii) Burn care takes place in the following treatment settings:

   1. (a) Burn unit/center—a facility with a discrete intensive care unit, dedicated beds, highly skilled staff and equipment and which treats major burn victims.
   2. (b) Burn program—a facility with the trained personnel and equipment to provide complete care of moderate uncomplicated burn injuries including rehabilitation.
   3. (c) Hospital emergency room—a facility treating minor burn injuries and providing emergency care for moderate and major burn injuries until appropriate referral transfer can take place.

3. (2) [Reserved]

   1. (i) End stage renal disease (ESRD) is a stage of renal impairment that appears irreversible or permanent and requires a regular course of dialysis or transplantation to maintain life.

   2. (ii) Dialysis is a process by which dissolved substances are removed from a patient's body by diffusion from one fluid compartment to another. The two types of dialysis in common use are:

      1. (a) hemodialysis, which is a process utilizing an artificial kidney to remove fluids and metabolic end products from the bloodstream; and
      2. (b) peritoneal dialysis, which is a process utilizing a natural semi-permeable membrane surrounding the peritoneal cavity to remove toxic metabolic waste products from the patient's bloodstream. This process takes place within the patient's body.
   3. (iii) Transplantation is a process by which (a) a kidney is excised from a live or cadaveric donor, (b) that kidney is implanted in an ESRD patient, and (c) supportive care is furnished to the living donor and to the recipient following implantation.
   4. (iv) Acute short-term dialysis is dialysis required by some persons on a short-term emergency basis as a result of a disease or accident.
   5. (v) End stage renal disease can be treated in such settings as specified in section 757.1 of this Subchapter.
   6. (vi) Self-dialysis is dialysis performed with little or no professional assistance by an ESRD patient who has completed an appropriate course of training.
   7. (vii) Home dialysis training is a program that trains ESRD patients to perform self- dialysis or home dialysis with little or no professional assistance, and trains other individuals to assist patients in performing self-dialysis or home dialysis.

   8. (viii) Need and utilization of the service will be determined using the following factors:

      1. (a) certified capacity, which is the number of stations approved to accommodate chronic renal dialysis patients per patient shift;
      2. (b) station, which is the combination of the chair, the water and electrical supply and the machine for treatment of the chronic renal patient; and

      3. (c) a patient shift, which is the length of time required to dialyze one patient, usually 4-5 hours.

         (4)

   9. (i) Computed tomography is a technique where a sharply collimated X-ray beam is passed from the gantry through the body from a source which rotates around the body in a specific arc. As the beam passes through the body from its perimeter, its intensity is reduced. The transmitted intensity of the beam varies in accordance with the density of the tissue it passes through and is measured by sensitive detectors and, from this information, cross- sectional pictures or other images may be generated. A computer is used to generate the image from the measurements of X-ray beam intensity. Tissue images can be done with or without contrast agents. Computed tomography services are rendered by computed tomography (C.T.) scanners.
   10. (ii) Computed tomography scanner is an imaging machine which combines the information generated by a scanning X-ray source and detector system with a computer to reconstruct an image of the full body, including the head.
   11. (iii) Scan or a patient procedure includes the initial image plus any additional images relating to the same area of diagnostic interest occurring during a single visit.
   12. (iv) A host facility for the purposes of this Part is a hospital which is certified to provide computed tomography services and houses a computer tomography scanner. A host facility provides services to members of a computed tomography scanner consortium and/or other institutions not certified for computed tomography services.
   13. (v) Computed tomography scanner consortium for purposes of this Part is a formal referral network of hospitals, all of which are certified to provide computed tomography scanning services which are provided by a host facility.

   (3)

4. (5) [Reserved]

   1. (i) Comprehensive physical medicine and rehabilitation. Rehabilitation is the process of providing, in a coordinated manner, those comprehensive services deemed appropriate to the needs of a person with a disability, in a program designated to achieve objectives of improved health, welfare, and realization of one's maximum physical, social, psychological, and vocational potential for useful and productive activity.

   2. (ii) A comprehensive inpatient physical medicine and rehabilitation program is a distinct organizational unit within a general hospital, a rehabilitation hospital, residential health care facility which provides coordinated and integrated services that include evaluation and treatment, and emphasizes education and training of those served. The program is applicable to those individuals who require an intensity of services which includes, as a minimum, physician coverage 24 hours per day, seven days per week, with daily (at least five days per week) medical supervision, complete medical support services including consultation, 24-hour-per-day nursing, and daily (at least five days per week) multidisciplinary rehabilitation programming for a minimum of three hours per day.

      1. (a) A spinal cord injury program provides coordinated and integrated services for spinal cord injured persons, whether from trauma or disease, within a designated area (beds) within a facility providing a comprehensive physical medicine and rehabilitation program, enabling those served to achieve optimal functions. A spinal cord injury program is consistent with the standards for a comprehensive inpatient physical medicine and rehabilitation program.
      2. (b) A brain injury program is an intensive rehabilitation program designed to prevent and/or minimize chronic disabilities while restoring the individual to the optimal level of physical, cognitive, and behavioral functioning. Persons served are generally not in a chronic vegetative state and the population of the unit consists primarily of those with traumatically acquired, nondegenerative, structural brain damage resulting in residual deficits and disability. Inclusion of other cerebral disorders should be based upon age, disability profiles, and service needs. The program is not intended to function as a stroke rehabilitation program, although some persons with a cerebral vascular accident may be served. A brain injury program is consistent with the standards for a comprehensive inpatient physical medicine and rehabilitation program.
   3. (iii) Outpatient physical medicine and rehabilitation is a program of coordinated and integrated evaluation and/or treatment services with emphasis on education and training of those served. It is applicable to those individuals with disabling impairments requiring an intensity of services including, as a minimum: medical supervision, medical support services and consultation, patient education, and appropriate allied therapies.

   (6)

5. (7) Emergency care begins in the prehospital setting, continues in the emergency facility, and concludes when the responsibility for the patient is transferred to another physician or the patient is discharged. The care of the patient during the continuum of emergency care is under the direction of the emergency physician who is responsible for the timely evaluation, treatment and transfer of the patient.

   1. (i) Emergency departments and emergency services. Emergency departments and emergency services consist of staff, facilities and resources to evaluate, initially manage, treat or transfer patients to another facility that can provide definitive treatment.
   2. (ii) An emergency visit is any unscheduled visit to the emergency facility.

(1)