Terms Used In Tennessee Code > Title 56 > Chapter 32 - Health Maintenance Organization Act of 1986

• Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
• affiliate: means any entity that exercises control over or is controlled by the HMO, directly or indirectly through:
  (A) Equity ownership of voting securities. See Tennessee Code 56-32-102
• 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.
• 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.
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Arrest: Taking physical custody of a person by lawful authority.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Attorney: means the person designated and authorized by subscribers as the attorney-in-fact having authority to obligate them on reciprocal insurance contracts. See Tennessee Code 56-16-102
• basic health care services: includes , but is not limited to, services made necessary as the result of Title XIX federal programs or waivers for which TennCare is primarily responsible for implementation or enforcement. See Tennessee Code 56-32-102
• 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}
• Chief officer: means the person with overall authority for a public or private hospital or treatment resource, or the person's designee. See Tennessee Code 33-1-101
• Child: means a person who is under eighteen (18) years of age. See Tennessee Code 33-1-101
• 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
• Coinsurance: means an enrollee's share of covered medical expenses when an enrollee and the HMO share in a specific ratio of the covered medical expenses. See Tennessee Code 56-32-102
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-32-102
• Commissioner: means the commissioner of mental health and substance abuse services. See Tennessee Code 33-1-101
• Community mental health center: includes for profit corporations and private entities qualified as tax exempt organizations under Internal Revenue Code, §. See Tennessee Code 33-1-101
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Consent: means voluntary agreement to what is reasonably well understood regardless of how the agreement is expressed. See Tennessee Code 33-1-101
• 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.
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Defense attorney: Represent defendants in criminal matters.
• Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
• Department: means the department of mental health and substance abuse services. See Tennessee Code 33-1-101
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Drug dependence: means drug abuse that results in the development of tolerance or manifestations of drug abstinence syndrome upon cessation of use. See Tennessee Code 33-1-101
• Enrollee: means an individual who is enrolled in an HMO. See Tennessee Code 56-32-102
• 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: 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.
• Evidence of coverage: means any certificate, agreement or contract issued to an enrollee setting out the coverage to which the enrollee is entitled. See Tennessee Code 56-32-102
• Foreign: when used without limitation, includes all companies formed by authority of any other state or government. See Tennessee Code 56-1-102
• Fraud: Intentional deception resulting in injury to another.
• Grand jury: agreement providing that a lender will delay exercising its rights (in the case of a mortgage,
• 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 to any individual of medical or dental care, or hospitalization, or incidental to the furnishing of the care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability. See Tennessee Code 56-32-102
• 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
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• 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.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• 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
• Month: means a calendar month. See Tennessee Code 1-3-105
• Net worth: means the excess of total admitted assets over total admitted liabilities, but the liabilities shall not include fully subordinated debt approved by the commissioner. See Tennessee Code 56-32-112
• 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.
• Oversight: Committee review of the activities of a Federal agency or program.
• 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 an individual, insurer, company, association, organization, Lloyds, society, reciprocal insurer or interinsurance exchange, partnership, syndicate, business trust, corporation, agent, general agent, broker, solicitor, service representative, adjuster, and every legal entity. See Tennessee Code 56-32-102
• Physician-hospital organization: means an organization formed to allow hospitals and physicians to jointly obtain provider contracts with HMOs and other payers of health care benefits. See Tennessee Code 56-32-102
• Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. ^{Source: OCC}
• premiums: as used in this chapter includes, but is not limited to, any and all payments made by the state to any entity providing health care services pursuant to any federal waiver received by the state that waives any or all of Title XIX of the federal Social Security Act, compiled in 42 U. See Tennessee Code 56-32-112
• Property: includes both personal and real property. See Tennessee Code 1-3-105
• Provider: means any physician, hospital or other person that is licensed or otherwise authorized in this state to furnish health care services. See Tennessee Code 56-32-102
• Qualified mental health professional: means a person who is licensed in the state, if required for the profession, and who is a psychiatrist. See Tennessee Code 33-1-101
• 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
• Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. 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
• Service recipient: means a person who is receiving service, has applied for service, or for whom someone has applied for or proposed service because the person has mental illness or serious emotional disturbance. See Tennessee Code 33-1-101
• 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.
• Statute: A law passed by a legislature.
• Subpoena: A command to a witness to appear and give testimony.
• Subscriber: means a person obligated under a reciprocal insurance agreement. See Tennessee Code 56-16-102
• Subscription: includes a mark, the name being written near the mark and witnessed. See Tennessee Code 1-3-105
• 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
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Treatment resource: means any public or private facility, service, or program providing treatment or rehabilitation services for mental illness or serious emotional disturbance, including, but not limited to, detoxification centers, hospitals, community mental health centers, clinics or programs, halfway houses, and rehabilitation centers. See Tennessee Code 33-1-101
• 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
• Venue: The geographical location in which a case is tried.
• Verdict: The decision of a petit jury or a judge.
• working capital: means current assets, including admitted stocks and admitted bonds, minus current liabilities. See Tennessee Code 56-32-112
• written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105