CA Health & Safety Code Section 127575

For purposes of this chapter, the following definitions shall apply:

(a)

“Carrier” means any of the following:

(1)

Any insurer, including, but not limited to, disability insurers, nonprofit hospital service plans, fraternal benefit societies, and firemen’s, policemen’s, or peace officers’ benefit and relief associations.

(2)

A health care service plan other than a specialized health care service plan.

(3)

A self-funded employer sponsored plan, multiple employer trust, or Taft-Hartley Trust as defined by federal law, authorized to pay for health care services in this state.

(4)

The State Compensation Insurance Fund.

(5)

The health insurance offered to certain employees of this state by the Public Employees’ Retirement System known as “PERS Care.”

(b)

“Department” means the State Department of Health Services.

(c)

“Office” means the Office of Statewide Health Planning and Development.

(d)

“Professional health care services” means any diagnostic or treatment services provided in California directly to a patient by a person licensed or practicing pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code who is eligible to directly bill for their services. “Professional health care services” does not include services provided by a person licensed pursuant to a chapter of Division 2 that the director of the office has determined, pursuant to Section 127590, should be exempted.

(e)

“Institutional provider services” means any services, equipment, and supplies, other than professional health care services that are provided by an institution, site, or facility through which professional health care services are provided. “Institutional provider services” includes any component of an episode of health care for which there will be charges, other than professional health care services. “Institutional provider services” does not include diagnostic or treatment services that would be considered “professional health care services” but for the fact that the provider is licensed under a chapter of Division 2 of the Business and Professions Code that the director of the office has exempted pursuant to Section 127590.

(f)

“California uniform billing form for professional health care services” and “California uniform billing form for institutional provider services” means billing forms in the formats developed by the office pursuant to Section 127580.