Terms Used In Louisiana Revised Statutes > Title 36 > Chapter 24 - Implementation of Reorganization

• Adverse determination: means any decision rendered by the recovery audit contractor that results in a payment to a provider for a claim or service being reduced either partially or completely. See Louisiana Revised Statutes 46:440.12
• Agency: means and includes the boards, commissions, departments, agencies, offices, officers, and other instrumentalities, or any or all of these, within the executive branch of state government which are abolished by this Title or which are transferred and placed within departments of the state government created and established or continued by this Title or transferred to and placed within the office of the governor as provided by this Title. See Louisiana Revised Statutes 36:3
• 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.
• Applicant: means a healthcare provider seeking to be approved or credentialed by a managed care organization to provide healthcare services to Medicaid enrollees. See Louisiana Revised Statutes 46:460.51
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Assistant secretary: means the officer designated by law or by the secretary of each department to carry out the duties and functions of an office within certain departments, except an office of management and finance and the office of state police of the Department of Public Safety and Corrections. See Louisiana Revised Statutes 36:3
• 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}
• Claim: means any request or demand, whether under a contract or otherwise, for money or property, whether or not the state or department has title to the money or property, that is drawn in whole or in part on medical assistance programs funds that are either of the following:

              (a) Presented to an officer, employee, or agent of the state or department. See Louisiana Revised Statutes 46:437.3

• Clerk of court: An officer appointed by the court to work with the chief judge in overseeing the court's administration, especially to assist in managing the flow of cases through the court and to maintain court records.
• Consumer product: means any tangible personal property that is distributed in commerce and used for personal, family, or household purposes, including any property intended to be attached to or installed in any real property without regard to whether it is attached or installed. See Louisiana Revised Statutes 51:3261
• Conviction: A judgement of guilt against a criminal defendant.
• 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.
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:437.3
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:440.12
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• Deputy secretary: means the officer authorized to be appointed by the secretary to serve as his principal administrative assistant. See Louisiana Revised Statutes 36:3
• Enrollee: means an individual who is enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Fraud: Intentional deception resulting in injury to another.
• Health care provider: means any person furnishing or claiming to furnish a good, service, or supply under the medical assistance programs, any other person defined as a health care provider by federal or state law or by rule, and a provider-in-fact. See Louisiana Revised Statutes 46:437.3
• High-volume third-party seller: means a participant on an online marketplace's platform who is a third-party seller and who has entered into two hundred or more discrete sales or transactions of new or unused consumer products in any twelve-month period during the previous twenty-four months, which result in an aggregate total of five thousand dollars or more in total gross revenue. See Louisiana Revised Statutes 51:3261
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
• Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
• Lien: A claim against real or personal property in satisfaction of a debt.
• Louisiana Colonial Trails: means a system of trails or roads identified as the migration route of the Camino Real in the western part of the state from Natchitoches to the Texas border and the Harrisonburg Road from Natchitoches through east central Louisiana to the Mississippi River. See Louisiana Revised Statutes 56:1952
• Medical assistance programs: means the Medical Assistance Program (Title XIX of the Social Security Act), commonly referred to as "Medicaid" and other programs operated by and funded in the department which provide payment to health care providers. See Louisiana Revised Statutes 46:437.3
• Office: means each principal operational unit within a department, except the executive office of the secretary. See Louisiana Revised Statutes 36:3
• Online marketplace: means any person or entity that operates a consumer-directed electronically based or accessed platform that meets all of the following criteria:

              (a) Has features that allow for, facilitate, or enable third-party sellers to engage in the sale, purchase, payment, storage, shipping, or delivery of a consumer product in this state. See Louisiana Revised Statutes 51:3261

• 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.
• Payment: means the payment to a health care provider from medical assistance programs funds pursuant to a claim, or the attempt to seek payment for a claim. See Louisiana Revised Statutes 46:437.3
• Person: means an individual, corporation, partnership, trust, association, joint venture pool, syndicate, sole proprietorship, unincorporated organization, or any other form of entity not specifically listed herein. See Louisiana Revised Statutes 9:3573.2
• Personal property: All property that is not real property.
• Plaintiff: The person who files the complaint in a civil lawsuit.
• Policy or procedure: shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services. See Louisiana Revised Statutes 46:460.51
• Prepaid Coordinated Care Network: means a private entity that contracts with the department to provide Medicaid benefits and services to Louisiana Medicaid managed care program enrollees in exchange for a monthly prepaid capitated amount per member. See Louisiana Revised Statutes 46:460.51
• Primary care case management: means a system under which an entity contracts with the state to furnish case management services that include but are not limited to the location, coordination, and monitoring of primary healthcare services to Medicaid beneficiaries. See Louisiana Revised Statutes 46:460.51
• provider: means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution that provides healthcare or professional services to individuals enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
• Provider: means any healthcare entity enrolled with the department as a provider in the Medicaid program. See Louisiana Revised Statutes 46:440.12
• Recipient: means an individual who is eligible to receive health care through the medical assistance programs. See Louisiana Revised Statutes 46:437.3
• Recoupment: means recovery through the reduction, in whole or in part, of payment to a health care provider. See Louisiana Revised Statutes 46:437.3
• Recovery: means the recovery of overpayments, damages, fines, penalties, costs, expenses, restitution, attorney fees, or interest or settlement amounts. See Louisiana Revised Statutes 46:437.3
• Secretary: means the secretary of the Louisiana Department of Health, or his authorized designee. See Louisiana Revised Statutes 46:437.3
• Secretary: means the secretary of the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• Secretary: means the officer appointed by the governor as the executive head and chief administrative officer of certain departments created and provided for by this Title. See Louisiana Revised Statutes 36:3
• Seller: means a person who sells, offers to sell, or contracts to sell a consumer product through an online marketplace platform. See Louisiana Revised Statutes 51:3261
• services: means the services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 46:460.51
• 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.
• Taxable year: includes , in the case of a return made for a fractional part of a year under the provisions of this Chapter or under regulations prescribed by the collector, the period for which return is made. See Louisiana Revised Statutes 47:98
• Telehealth: has the meaning ascribed in Louisiana Revised Statutes 46:460.51
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Third-party seller: means any seller, independent of an online marketplace, who sells, offers to sell, or contracts to sell a consumer product in this state through an online marketplace. See Louisiana Revised Statutes 51:3261
• Undersecretary: means the officer designated to direct and be responsible for the functions of the office of management and finance of certain departments. See Louisiana Revised Statutes 36:3
• Verify: means to confirm information provided to an online marketplace pursuant to this Chapter, which may include the use of one or more methods that enable the online marketplace to reliably determine that any information and documents provided are valid, corresponding to the seller or an individual acting on the seller's behalf, not misappropriated, and not falsified. See Louisiana Revised Statutes 51:3261