Title 43, Chapter 1B, Section 3
( 43-1B-3)
As used in this chapter, the term: (1) "Board" means any professional licensing board which, under
the laws of this state, licenses, registers, or in any other way
regulates any health care provider to whom this chapter applies. (2) "Designated health services" means clinical laboratory
services, physical therapy services, rehabilitation services,
diagnostic imaging services, pharmaceutical services, durable
medical equipment, home infusion therapy services (including
related pharmaceuticals and equipment), home health care services,
and outpatient surgical services. (3) "Entity" means any individual, partnership, firm, corporation,
or other business entity. (4) "Fair market value" means value in arm's length transactions
consistent with the general market value and, with respect to
rentals or leases, the value of rental property for general
commercial purposes, not taking into account its intended use,
and, in the case of a lease of space, not adjusted to reflect the
additional value the prospective lessee or lessor would attribute
to the proximity or convenience to the lessor where the lessor is
a potential source of patient referrals to the lessee. (5) "Group practice" means a group of two or more health care
providers legally organized as a partnership, professional
corporation, or similar association: (A) In which each health care provider who is a member of the
group provides substantially the full range of services which
the health care provider routinely provides, including medical
care, consultation, diagnosis, or treatment, through the joint
use of shared office space, facilities, equipment, and
personnel; (B) For which substantially all of the services of the health
care providers who are members of the group are provided through
the group and are billed in the name of the group and amounts so
received are treated as receipts of the group; and (C) In which the overhead expenses of and the income from the
practice are distributed in accordance with methods previously
determined by members of the group. (6) "Health care provider" means a physician, chiropractor,
podiatrist, optometrist, pharmacist, or physical therapist who is
licensed or otherwise regulated under this title. (7) "Immediate family member" means a health care provider's
spouse, child, child's spouse, grandchild, grandchild's spouse,
parent, parent-in-law, or sibling. (8) "Investment interest" means an equity or debt security issued
by an entity, including, without limitation, shares of stock in a
corporation, units or other interests in a partnership, bonds,
debentures, notes, or other equity interests or debt instruments.
The following investment interests shall be excepted from this
definition: (A) An investment interest in an entity that is a provider of a
designated health service solely in a rural area; (B) An investment interest in notes, bonds, debentures, or other
debt instruments issued by an entity which provides designated
health services, as an integral part of a plan by such entity to
acquire such investor's equity investment interest in the
entity, provided that the interest rate is consistent with fair
market value, and that the maturity date of the notes, bonds,
debentures, or other debt instruments issued by the entity to
the investor is not later than July 1, 1996; (C) An investment interest in real property resulting in a
landlord-tenant relationship between the health care provider
and the entity in which the equity interest is held, unless the
rent is determined, in whole or in part, by the business volume
or profitability of the tenant or exceeds fair market value; (D) A financial relationship between a university, college, or
other entity providing education and training in the health
sciences, including its owned and affiliated hospitals, and any
entity or entities through which its faculty and employees who
are health care providers provide designated health services; or (E) An investment interest in a publicly held corporation with
total assets over $50 million whose shares are traded on a
national exchange or over-the-counter market if the investment
interest is less than 1 percent of the corporation, there are no
special stock classes for health care provider investors, and no
income from the investment interest is tied to the volume of
referrals. (9) "Investor" means a health care provider or entity owning a
legal or beneficial ownership or investment interest, directly or
indirectly, including, without limitation, through an immediate
family member, trust, or another entity related to the investor
within the meaning of 42 C.F.R. subsection 413.17, in an entity. (10) "Referral" means any referral of a patient for health care
services, including, without limitation: (A) The forwarding of a patient by a health care provider to
another health care provider or to an entity which provides or
supplies designated health services or any other health care
item or service; (B) The request or establishment of a plan of care by a health
care provider which includes the provision of designated health
services or other health care item or service; or (C) The following orders, recommendations, or plans of care
shall not constitute a referral by a health care provider: (i) By a radiologist for diagnostic imaging services; (ii) By a health care provider specializing in the provision
of radiation therapy services for such services;
(iii) By a health care provider referring within the health
care provider's group practice; (iv) By a pathologist for diagnostic clinical laboratory tests
and pathological examination services, if furnished by or
under the supervision of such pathologist pursuant to a
consultation requested by another health care provider; (v) By a staff health care provider of a hospital referring a
patient to the hospital at which the health care provider has
current staff privileges; (vi) By a health care provider for items or services provided
by such health care provider or by a member of such health
care provider's group practice to the patients of that health
care provider or group practice or items or services provided
or performed at the direction or under the supervision of such
health care provider or group practice; or (vii) By a health care provider when the patient is in need of
emergency health care services where any delay in treatment
could reasonably be expected to jeopardize the life or health
of the person affected. (11) "Rural area" means a county with a population density of no
greater than 65 persons per square mile, as defined by the United
States decennial census of 1990. |