Pennsylvania Statutes Title 62 P.S. Poor Persons and Public Welfare § 501-A. Definitions

The following words and phrases when used in this article shall have the meanings given to them in this section unless the context clearly indicates otherwise:

“All Patient Refined Diagnosis Related Groups.”A version of Diagnosis Related Groups that further subdivide the Diagnosis Related Groups into four severity-of-illness and four risk-of-mortality subclasses within each Diagnosis Related Groups.

“Diagnosis Related Groups.”A classification system that uses patient discharge information to classify patients into clinically meaningful groups.

“Hospital.” A public or private institution licensed as a hospital under the laws of this Commonwealth that participates in the Medicaid program.

“Managed care organization.”A licensed managed care organization with whom the department has contracted to provide or arrange for services to a Medicaid recipient.

“Medicaid program.”The Commonwealth's medical assistance program authorized under Article IV.

“Potentially avoidable admission.”An admission of an individual to a hospital or long-term care facility that may have reasonably been prevented with adequate access to ambulatory care or health care coordination.

“Potentially avoidable complication.”A harmful event or negative outcome with respect to an individual, including an infection or surgical complication, that:

“Potentially avoidable emergency visit.”Treatment of an individual in a hospital emergency room or freestanding emergency medical care facility for a condition that may not require emergency medical attention because the condition could be or could have been treated or prevented by a physician or other health care provider in a nonemergency setting.

“Potentially avoidable event.”Any of the following:

“Potentially avoidable readmission.”A return hospitalization of an individual within a period specified by the department that may have resulted from a deficiency in the care or treatment provided to the individual during a previous hospital stay or from a deficiency in posthospital discharge follow-up. The term does not include a hospital readmission necessitated by the occurrence of unrelated events after the discharge. The term includes the readmission of an individual to a hospital for: