68-11-201 - Definitions. [Amended effective January 1, 2010. See the Compiler's Notes.] - Tennessee Statutes

68-11-201. Definitions. [Amended effective January 1, 2010. See the Compiler's Notes.]

As used in this part, unless the context otherwise requires:

     (1)  [Deleted by 2009 amendment.]

     (2)  [Deleted by 2009 amendment.] [Effective January 1, 2010. See the Compiler’s Notes.]

     (3 )  “Adult care home” means a single family residence licensed pursuant to this part in which twenty-four-hour residential care, including assistance with activities of daily living, is provided in a homelike environment to no more than five (5) elderly or disabled adults. Adult care homes shall be licensed as Level 2 homes, and meet standards prescribed in this part and in regulations promulgated by the board pursuant to this part. “Adult care home” does not include any facility otherwise licensed by the department of mental health and developmental disabilities; [Effective January 1, 2010. See the Compiler’s Notes.]

     (4)  “Adult care home provider” means a person twenty-one (21) years of age or older who owns and operates an adult care home and meets all education, training and experience requirements prescribed in this part and in regulations promulgated by the board pursuant to § 68-11-209. An adult care home provider may serve up to five (5) elderly or disabled adults who are unrelated to the adult care home provider by blood or marriage. An adult care home provider may choose to serve one (1) or more elderly or disabled adult members of their own family, in which case, the adult care home provider shall be required to serve at least two (2) additional elderly or disabled adults unrelated to the adult care home provider by blood or marriage, for a total of no more than five (5) elderly or disabled residents served in the adult care home. An adult care home provider shall live in the adult care home or employ a resident manager to live in the residence;

     (5)  “Ambulatory surgical treatment center” means any institution, place or building devoted primarily to the maintenance and operation of a facility for the performance of surgical procedures or any facility in which a medical or surgical procedure is utilized to terminate a pregnancy. Such facilities shall not provide beds or other accommodations for the stay of a patient to exceed twelve (12) hours duration; provided, that the length of stay may be extended for an additional twelve (12) hours in the event such stay is deemed necessary by the attending physician, the facility medical director, or the anesthesiologist for observation or recovery, but in no event shall the length of stay exceed twenty-four (24) hours. No patient for whom a medical or surgical procedure is utilized to terminate a pregnancy shall stay at such a facility for a period exceeding twelve (12) hours. Individual patients shall be discharged in an ambulatory condition without danger to the continued well-being of the patients or shall be transferred to a hospital. Excluded from this definition are the private physicians' and dentists' office practices, except those private physicians' and dentists' offices in which a substantial number of medical or surgical pregnancy terminations are performed;

     (6)  The purpose of assisted-care living facility services is to promote the availability of residential alternatives to institutional care for persons who are elderly or who have disabilities in the least restrictive and most homelike environment appropriate. Assisted-care living facility services shall be driven by a philosophy that emphasizes personal dignity, respect, autonomy, independence and privacy and should, to the maximum extent appropriate, enhance the person's ability to age in place, while also ensuring that the person's medical and other needs are safely and effectively met.

          (A)  “Assisted-care living facility” means a facility, building, establishment, complex or distinct part thereof that accepts primarily aged persons for domiciliary care and services as described in this section.

          (B)  An assisted-care living facility shall provide on site to its residents room and board and non-medical living assistance services appropriate to each resident's needs, such as assistance with bathing, dressing, grooming, preparation of meals and other activities of daily living.

          (C)  Subject to limitations specified in this subdivision (6), an assisted-care living facility may also provide onsite to its residents administration of medications that are typically self-administered, excluding intravenous injections, except as permitted pursuant to subdivisions (7)(D) and (E), and all other medical services as prescribed by each resident's treating physician that could be provided to a private citizen in the person’s own home by an appropriately licensed or qualified health care professional or entity, such as part-time or intermittent nursing care, various therapies including physical, occupational and speech therapy, podiatry care, medical social services, medical supplies other than drugs and biologicals, durable medical equipment and hospice services.

                (i)  Such medical services that may be provided in the assisted-care living facility must be provided by appropriately licensed or qualified staff or contractors of the assisted-care living facility, a licensed home care organization, another appropriately licensed entity or by the appropriately licensed staff of a nursing home, acting within the scope of their respective licenses.

                (ii)  Nothing in this subdivision (6) shall authorize assisted-care living facilities to provide medical services to assisted-care living facility residents if the services are reimbursable under the federal medicare program.

                (iii)  Oversight of medical services provided by licensed health care professionals and entities in an assisted-care living facility shall be provided in a manner that is consistent with the oversight of services provided by the licensed health care professionals or entities in private residential settings as defined through rules and regulation promulgated by the applicable licensing board and as may be further defined through rules and regulations promulgated by the board for licensing health care facilities pursuant to this section to ensure the quality of care received.

                (iv)  The assisted-care living facility shall be responsible for the development of a plan of care that ensures the safety and well-being of the resident's living environment and for the provision of the resident's health care needs. Furthermore, any licensed health care professional or entity that is delivering services to the resident in the assisted-care living facility shall be available to assist in the plan of care development and to assess, plan, monitor, direct and evaluate the resident's care in conjunction with the resident's physician and in cooperation with the assisted-care living facility.

                (v)  Assisted-care living facilities shall be subject to licensure and must meet such requirements and minimum standards as the board prescribes in regulations pursuant to § 68-11-209. In the regulations, the board shall specifically address the needs of residents who may receive medical services provided pursuant to this part, including documentation of physician orders and nursing and treatment records of all medical services provided in the assisted-care living facility in an appropriate medical record maintained by the facility, regardless of whether the services are rendered by appropriately licensed or qualified staff of the assisted-care living facility or by arrangement with an outside entity.

                (vi)  The board shall also, in consultation with the state fire marshal, include in such regulations fire safety standards that afford reasonable protection to assisted-care living facility residents without unduly disturbing the residential atmosphere to which they are accustomed;

     (7)  “Assisted-care living facility resident” means primarily an aged person who requires domiciliary care and who, upon admission to the facility, if not ambulatory, is capable of self-transfer from the bed to a wheelchair or similar device and is capable of propelling the wheelchair or similar device independently. Such resident may require one (1) or more of the services described in subdivision (6).

          (A)  An assisted-care living facility resident shall be transferred to a licensed hospital, licensed nursing home or other appropriate setting if the resident, the appropriate person with legal authority to make such decisions on behalf of the resident, the assisted-care living facility administrator or the resident's treating physician determine that the services available to the resident in the assisted-care living facility, including medical services provided pursuant to subdivision (6)(C), will not safely and effectively meet the resident's needs. This subdivision (7)(A) shall not be interpreted as limiting the authority of the board or the department to require the transfer or discharge of individuals to different levels of care as required by statute when the resident's needs cannot be safely and effectively met by care provided in the assisted-care living facility, including medical services provided pursuant to subdivision (6)(C).

          (B)  Subject to limitations specified in subdivisions (7)(C) and (D), an assisted-care living facility may admit and permit the continued stay of a person who meets medical eligibility, i.e., level of care requirements for nursing facility services as defined by the bureau of TennCare, so long as the person's treating physician certifies that the person's needs can be safely and effectively met by care provided in the assisted-care living facility, including medical services provided pursuant to subdivision (6)(C), and the assisted-care living facility can provide assurance of timely evacuation in a fire or emergency.

          (C)  Assisted-care living facilities shall not admit nor permit the continued stay of:

                (i)  A person requiring treatment for a stage III or IV decubitus ulcer or with exfoliative dermatitis;

                (ii)  A person who requires continuous nursing care. For purposes of this subdivision (7)(C)(ii), “continuous nursing care” means round-the-clock observation, assessment, monitoring, supervision or provision of nursing services that can only be performed by a licensed nurse;

                (iii)  A person who has an active, infectious and reportable disease in a communicable state that requires contact isolation;

                (iv)  A person whose verbal or physical aggressive behavior poses an imminent physical threat to the person or others, based not on the person's diagnosis, but on the behavior of the person;

                (v)  A person requiring physical or chemical restraints, not including psychotropic medications prescribed for a manageable mental disorder or condition; or

                (vi)  A person whose needs cannot be safely and effectively met in the assisted-care living facility.

          (D)  Assisted-care living facilities shall not admit, but may permit the continued stay in the facility of, existing residents who require the treatments specified in subdivisions (7)(D)(i)-(iv) only on an intermittent basis or who are receiving hospice care from an appropriately licensed provider, as permitted pursuant to subdivision (7)(E). If the treatments are intermittent and extend beyond twenty-one (21) days, no more than two (2) additional twenty-one-day extensions may be granted by the assisted-care living facility; provided, that the resident's treating physician certifies that the person's intermittent need for the treatment can be safely and effectively met by care provided in the assisted-care living facility, including medical services provided pursuant to subdivision (6)(C). Assisted-care living facilities shall not permit the continued stay in the facility of existing residents who require the treatments on an ongoing, rather than intermittent basis, unless a resident who requires the treatments on an ongoing basis does not qualify for nursing facility level of care, in which case a waiver may be granted by the board for licensing health care facilities allowing the person to remain in the assisted-care living facility. A person who requires any of the treatments specified in subdivisions (7)(D)(i)-(iv) and who is able to self-care for the person's condition without the assistance of facility personnel or other appropriately licensed entity shall not be subject to these limitations and may be admitted or permitted to continue as a resident in an assisted-care living facility:

                (i)  Nasopharyngeal or tracheotomy aspiration;

                (ii)  Nasogastric feedings;

                (iii)  Gastrostomy feedings; or

                (iv)  Intravenous therapy or intravenous feedings.

          (E)  Notwithstanding any other provision of this subdivision (7), any assisted-care living facility resident, including residents and new admissions who have qualified for hospice care prior to admission to the assisted-care living facility, shall be able to receive hospice care services and continue as a resident of the assisted-care living facility as long as the resident's treating physician certifies that hospice care can be appropriately provided at the facility. In addition, the hospice provider and the assisted-care living facility are jointly responsible for the development of a plan of care that ensures the safety and well-being of the resident's living environment and for the provision of the resident's health care needs. Furthermore, the hospice provider shall be available to assess, plan, monitor, direct and evaluate the resident's palliative care in conjunction with the resident's physician and in cooperation with the assisted-care living facility.

          (F)  The board for licensing health care facilities shall not promulgate any regulation, make any determination, issue any waiver, take any action or refuse to take action that has the effect of permitting an assisted-care living facility to provide care to persons or to admit or permit the continued stay of such persons except in accordance with this subdivision (7);

     (8)  “Assistive technology practitioner (ATP)” means service providers primarily involved in evaluating the consumer's needs and training in the use of a prescribed wheeled mobility device;

     (9)  “Assistive technology supplier (ATS)” means service providers involved in the sale and service of commercially available wheeled mobility devices;

     (10)  “Birthing center” means any institution, facility, place or building devoted exclusively or primarily to the provision of routine delivery services and postpartum care for mothers and their newborn infants;

     (11)  “Board,” unless otherwise indicated, means the board for licensing health care facilities;

     (12)  “Commissioner” means the commissioner of health, the commissioner's authorized representative, or in the event of the commissioner's absence or a vacancy in the office of commissioner, the deputy commissioner of health;

     (13)  “Council” means, unless otherwise indicated, the state public health council;

     (14)  [Deleted by 2007 amendment.]

     (15)  “Dentist” means a doctor of dental science who is duly licensed to practice dentistry in this state;

     (16)  “Department” means the department of health;

     (17)  “Evaluation” means the determination and documentation of the physiological and functional factors that impact the selection of an appropriate seating and wheeled mobility device;

     (18)  “Facility” means any institution, place or building providing health care services that is required to be licensed under this chapter;

     (19)  “HIV resident” means any individual who is in need of domiciliary care and who has been diagnosed and certified in writing by a licensed physician as being human immunodeficiency virus (HIV) positive;

     (20)  (A)  “Home care organization” provides home health services, home medical equipment services, professional support services or hospice services to patients on an outpatient basis in either their regular or temporary place of residence. An entity is a home care organization if it does any of the following:

                (i)  Holds itself out to the public as providing home health services, home medical equipment services or hospice services;

                (ii)  Contracts or agrees to deliver home health services, home medical equipment services or hospice services;

                (iii)  Accepts, in the organization's name, physician orders for home health services, home medical equipment services or hospice services;

                (iv)  Accepts responsibility for the delivery of home health services, home medical equipment services or hospice services; or

                (v)  Contracts to provide professional support services with the state agency financially responsible for services to individuals with mental retardation or developmental disabilities;

          (B)  The absence of one (1) or more of the factors in (20)(A)(i)-(v) does not necessarily exclude the entity from the meaning of this definition;

          (C)  If the entity is not included within the terms of this definition, the entity shall not be considered to be a home care organization solely because it offers to refer individuals who are available for employment by consumers through personal contract or individual agreement to deliver home health services, home medical equipment services, professional support services or hospice services that are either within the scope of the individual's professional license or is a homemaker service, and which service must be delivered independently of the agency or organization that made the referral;

          (D)  The board shall establish, by rules, standards of authorization for a home care organization to be qualified to provide home health services, home medical equipment services or hospice services. No person shall provide a designated category of services unless appropriately authorized by the board. Licensure surveys of a home care organization shall be specific to the type of service categories for which the home care organization has been authorized. The standards for hospice shall include requirements for a medically directed team of professionals and volunteers to create a program of care to meet the medical, nursing, social, psychological, emotional, spiritual and other special needs that are experienced in the final stages of illness, during dying and bereavement for families following the death of the patient. The standards for licensure of professional support services shall be the same as those applicable to personal support services agencies licensed under title 33; provided, that the department adopts by rule additional standards specifically for professional support services after consultation with the commissioner of mental health and developmental disabilities. In regulating home care organizations authorized to provide professional support services, the department shall rely on the review of the organizations conducted by the department of mental health and developmental disabilities, and the survey by the department of the organization shall not duplicate the reviews conducted by the department of mental health and developmental disabilities;

     (21)  (A)  “Home for the aged” means a home represented and held out to the general public as a home which accepts primarily aged persons for relatively permanent, domiciliary care. A home for the aged provides room, board and personal services to four (4) or more nonrelated persons;

          (B)  The residential home for the aged shall be subject to licensure and meet such requirements and minimum standards as the board shall prescribe in regulations pursuant to § 68-11-209. The board shall, after consultation with the state fire marshal, include in the regulations fire safety standards that afford reasonable protection to homes for the aged residents without unduly disturbing the residential atmosphere to which they are accustomed. No license to operate a residential home for the aged shall be issued if the home is not approved by the local zoning, building and fire safety authorities to provide residential custodial care. The board shall employ one (1) or more fire safety experts who shall be annually certified to be qualified in fire safety by the state fire marshal. Notwithstanding approval of a home by the local authorities, the board shall consider any recommendation of its staff member or members thus certified to be qualified in deciding whether an application for a license to operate a residential home for the aged ought to be granted. In the absence of local authority and when deemed necessary by the board, approval of the home by the board's certified fire safety expert is required. The board has sole authority to issue and revoke licenses for homes for the aged. The board has the authority to establish fees. The board has the authority to determine whether or not any institution or agency comes within the scope of this part, and its decisions in that regard shall be subject only to such rights of review as the courts exercise with respect to administrative actions;

     (22)  “Home for the aged resident” means a person who is ambulatory and who requires permanent, domiciliary care but will be transferred to a licensed hospital, a licensed assisted living facility, or a licensed nursing home when health care services are needed that must be provided in those other facilities;

     (23)  “Home health service” means a service provided an outpatient by an appropriately licensed health care professional or an appropriately qualified staff member of a licensed home care organization in accordance with orders recorded by a physician, that includes one (1) or more of the following:

          (A)  Skilled nursing care, including part-time or intermittent supervision;

          (B)  Physical, occupational or speech therapy;

          (C)  Medical social services;

          (D)  Home health aide services;

          (E)  Medical supplies and medical appliances, other than drugs and pharmaceuticals, when provided or administered as part of, or through the provision of, the services described in subdivisions (20)(A)-(D);

          (F)  Any of the items and services listed in subdivisions (23)(A)-(E) that are provided on an outpatient basis under arrangements made by the home care organization at a hospital, nursing home facility or rehabilitation center and the furnishing of which involves the use of equipment of such a nature that the items and services cannot readily be made available to the individual in the individual's home, or that are furnished at such facility while the individual is there to receive any such item or service, but not including transportation of the individual in connection with any such item or service;

          (G)  (i)  For the purpose of defining “home health service” only, “physician” also includes a person who is licensed to practice medicine or osteopathy in a state contiguous to Tennessee, to the extent the physician has referred a patient residing in this state to a home care organization licensed under this part; provided, that nothing in this subdivision (23)(G) shall be construed as authorizing a non-resident physician or osteopath to practice in violation of § 63-6-201 or § 63-9-104, respectively. A physician who is not licensed to practice medicine or osteopathy in this state shall not refer a patient who is a resident of this state to a home care organization licensed under this part, unless the physician has previously provided treatment to the patient and has had an ongoing physician-patient relationship with the person for whom the referral is made;

                (ii)  For the purposes of defining “home health service” only, “physician” includes a podiatrist licensed under title 63, chapter 3; provided, however, that any home health service ordered is a follow-up to treatment provided to the patient by the podiatrist;

          (H)  Notwithstanding the provisions of any other law to the contrary, a licensed practical nurse employed by a home care organization, acting pursuant to the written order of a licensed physician, may provide respiratory care to a home care organization patient, except for the maintenance and management of life support equipment;

          (I)  Home- and community-based services provided to individuals through the department of education or a local education agency and home- and community-based services provided to individuals by a county health department are not home health services for purposes of this chapter; and

          (J)  “Home health service” does not include services provided in the home by a sole practice therapist, when such services are within the scope of the therapist's license and incidental to services provided by the sole practice therapist in the office. For purposes of this subdivision (23)(J), a sole practice therapist means a therapist licensed under title 63, chapter 13 or 17, who is in sole practice and not in a business arrangement with any other therapist or other healthcare provider. Nothing in this subdivision (23)(J) shall exclude a sole therapist from the requirement of this section relative to professional support services;

     (24)  (A)  “Home medical equipment” means medical equipment intended for use by the consumer, including, but not limited to, the following:

                (i)  A device, instrument, apparatus, machine, or other similar article whose label bears the statement: “Caution: Federal law requires dispensing by or on the order of a physician.”;

                (ii)  Ambulating assistance equipment;

                (iii)  Mobility equipment;

                (iv)  Rehabilitation seating;

                (v)  Oxygen care equipment and oxygen delivery systems;

                (vi)  Respiratory care equipment and respiratory disease management devices;

                (vii)  Rehabilitation environmental control equipment;

                (viii)  Ventilators;

                (ix)  Apnea monitors;

                (x)  Diagnostic equipment;

                (xi)  Feeding pumps;

                (xii)  A bed prescribed by a physician to treat or alleviate a medical condition;

                (xiii)  Transcutaneous electrical nerve stimulator;

                (xiv)  Sequential compression devices; and

                (xv)  Neonatal home phototherapy devices;

          (B)  “Home medical equipment” does not include:

                (i)  Medical equipment used or dispensed in the normal course of treating patients by hospitals and nursing facilities as defined in this part, other than medical equipment delivered or dispensed by a separate unit or subsidiary corporation of a hospital or nursing facility or agency that is in the business of delivering home medical equipment to an individual's residence;

                (ii)  Upper and lower extremity prosthetics and related orthotics;

                (iii)  Canes, crutches, walkers, and bathtub grab bars;

                (iv)  Medical equipment provided through a physician's office incident to a physician's service;

                (v)  Equipment provided by a pharmacist which is used to administer drugs or medicine that can be dispensed only by a pharmacist; or

                (vi)  Enteral and parenteral equipment provided by a pharmacist;

     (25)  “Home medical equipment provider” means any person who provides home medical equipment services;

     (26)  “Home medical equipment services” means a service provided by any person who sells or rents home medical equipment for delivery to the consumer's place of residence in this state, regardless of the location of the home medical equipment provider. For purposes of this subdivision (26), “delivery to the consumer's place of residence” includes shipment by the home medical equipment provider to the consumer's residence or shipment to a predetermined location with the understanding that the home medical equipment shall be picked up by the consumer or the consumer's representative;

     (27)  “Hospice patient” means only a person who has:

          (A)  Been diagnosed as terminally ill;

          (B)  Been certified by a physician, in writing, to have an anticipated life expectancy of six (6) months or less; and

          (C)  Voluntarily requested admission to, and been accepted by a licensed hospice;

     (28)  “Hospice services” means a coordinated program of care, under the direction of an identifiable hospice administrator, providing palliative and supportive medical and other services to hospice patients and their families in the patient's regular or temporary place of residence. Hospice services shall be available twenty-four (24) hours a day, seven (7) days a week pursuant to the patient's hospice plan of care. Notwithstanding any other law, a licensed hospice may provide services to a person who is not a hospice patient; provided, that services to a non-hospice patient shall be limited to palliative care only. Hospice services may be provided in an area designated by a hospital for exclusive use by a home care organization certified as a hospice provider to provide care at the hospice inpatient or respite level of care in accordance with the hospice's medicare certification. Admission to the hospital is not required in order for a patient to receive hospice services, regardless of the patient's length of stay. The designation by a hospital of a portion of its facility for exclusive use by a home care organization to provide hospice services to its patients shall not:

          (A)  Alter the license to bed complement of such hospital; or

          (B)  Result in the establishment of a residential hospice;

     (29)  (A)  “Hospital” means any institution, place, building or agency represented and held out to the general public as ready, willing and able to furnish care, accommodations, facilities and equipment for the use, in connection with the services of a physician or dentist, of one (1) or more nonrelated persons who may be suffering from deformity, injury or disease or from any other condition for which nursing, medical or surgical services would be appropriate for care, diagnosis or treatment;

          (B)  “Hospital” does not include any hospital or institution, operated by the department of mental health and developmental disabilities, specially intended for use in the diagnosis, care and treatment of those suffering from mental illness, mental retardation, convulsive disorders, or other abnormal mental conditions;

          (C)  All hospitals, including such hospitals as are strictly maternity hospitals, shall come within this part;

          (D)  The board has the authority to determine whether or not any institution or agency comes within the scope of this part, and its decisions in that regard shall be subject only to such rights of review as the courts exercise with respect to administrative actions;

          (E)  It is unlawful for any institution, place, building or agency to be called a hospital if it is not a hospital as defined in this section;

     (30)  “Hospitalization” in a hospital means the reception and care of any person for a continuous period longer than twenty-four (24) hours, for the purpose of giving advice, diagnosis, nursing service or treatment bearing on the physical health of such persons, and maternity care involving labor and delivery for any period of time;

     (31)  (A)  “Nursing home” means any institution, place, building or agency represented and held out to the general public for the express or implied purpose of providing care for one (1) or more nonrelated persons who are not acutely ill, but who do require skilled nursing care and related medical services;

          (B)  “Nursing home” shall be restricted to facilities providing skilled nursing care and related medical services to individuals, beyond the basic provision of food, shelter and laundry, admitted because of illness, disease or physical infirmity for a period of not less than twenty-four (24) hours per day;

     (32)  “Oral surgeon” means a dentist who has been certified by the Tennessee board of dentistry to perform oral surgery;

     (33)  (A)  “Outpatient diagnostic center,” except as otherwise limited in this subdivision (33), means any facility providing outpatient diagnostic services, unless the outpatient diagnostic services are provided as the services of another licensed healthcare institution that reports such outpatient diagnostic services on its joint annual report, or the facility is otherwise excluded from this subdivision (33). As used in this subdivision (33), “outpatient diagnostic services” means the following services provided to any person who is not an inpatient of a hospital: computerized tomography, magnetic resonance imaging, positron emission tomography, or other imaging technology developed after June 9, 2005, that provides substantially the same functionality as computerized tomography, magnetic resonance imaging, or positron emission tomography and for which a certificate of need is required by this chapter. With respect to an outpatient diagnostic center, data shall be reported to the commissioner of health pursuant to § 68-1-119, but the commissioner shall not make such data available to any third parties, except approved vendors that process the data, until the data is made publicly available;

          (B)  “Outpatient diagnostic center” does not mean a physician or dental practice that is conducted at a location occupied and controlled by one (1) or more physicians or dentists licensed under title 63, if the outpatient diagnostic services are ancillary to the specialties of the physicians' practice or are provided primarily for persons who are patients of the physicians or dentists in the practice for purposes other than outpatient diagnostic services. Outpatient diagnostic services provided in settings other than outpatient diagnostic centers or ambulatory surgery treatment centers shall be reported to the department of health, in the same manner as if such services were provided in an outpatient diagnostic center;

     (34)  “Patient” includes, but is not limited to, any person who is suffering from an acute or chronic illness or injury or who is crippled, convalescent or infirm, or who is in need of obstetrical, surgical, medical, nursing or supervisory care;

     (35)  “Person” means any individual, partnership, association, corporation, other business entity, state or local governmental agencies and entities, and federal agencies and entities to the extent permitted by federal law;

     (36)  “Physician” means a doctor of medicine or doctor of osteopathy who is duly licensed to practice the profession in the state of Tennessee;

     (37)  “Prescribed child care center” means a nonresidential child care, health care/child care center providing physician prescribed services and appropriate developmental services for six (6) or more children who are medically or technology dependent and require continuous nursing intervention. “Child care” for purposes of this section means the provision of supervision, protection, and meeting the basic needs of children, who are not related to the primary care givers, for three (3) or more hours a day, but less than twenty-four (24) hours a day;

     (38)  “Professional support services” means nursing and occupational, physical or speech therapy services provided to individuals with mental retardation or developmental disabilities pursuant to a contract with the state agency financially responsible for such services;

     (39)  “Qualified rehabilitation professional” means:

          (A)  A health care professional within the professional's scope of practice licensed under title 63; or

          (B)  An individual who has appropriately obtained the designation of ATP or ATS, meeting all requirements of the designation of ATP or ATS, as established by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA);

     (40)  (A)  “Recuperation center” means an establishment with permanent facilities that include inpatient beds, with an organized medical staff, and with medical services, including physician services and continuous nursing services, to provide treatment for patients who are not in an acute phase of illness, but who currently require primarily convalescent or restorative services, usually post-acute hospital care of relatively short duration;

          (B)  An establishment furnishing primarily domiciliary care is not within this definition;

          (C)  Matters pertaining to recuperation centers shall come within the purview of the board;

     (41)  “Renal dialysis clinic” means any institution, facility, place or building devoted to the provision of renal dialysis on an outpatient basis to persons diagnosed with end stage renal disease; [Effective January 1, 2010. See the Compiler’s Notes.]

     (42)  “Resident manager” means a person twenty-one (21) years of age or older who lives in an adult care home and oversees the day-to-day operation of the adult care home on behalf of the adult care home provider and meets all education, training and experience requirements prescribed in this part and in regulations promulgated by the board pursuant to § 68-11-209;

     (43)  “Residential HIV supportive living facility” means any institution, facility, place or building devoted exclusively to the provision of residential supportive living services to residents diagnosed with human immunodeficiency virus (HIV);

     (44)  “Residential hospice” means a licensed homelike residential facility designed, staffed and organized to provide hospice or HIV care services, or both, except the services shall be provided at the residential facility rather than the patient's regular or temporary place of residence. A residential hospice shall not provide hospice or HIV care services to any person other than a hospice patient defined in subdivision (27), or HIV resident defined in subdivision (19). The board shall establish, by rules and regulations, residential hospice standards, which shall include provisions for building construction and fire and safety features, in addition to standards otherwise applicable to hospice or HIV care services provided by home care organizations; [Effective January 1, 2010. See the Compiler’s Notes.]

     (45 )  “Substitute caregiver” means any person twenty-one (21) years of age or older who temporarily oversees care and services in an adult care home during the short-term absence of the adult care home provider or resident manager and meets all education, training and experience requirements prescribed in this part and in regulations promulgated by the board pursuant to § 68-11-209; and

     (46)  “Wheeled mobility device” means a wheelchair or wheelchair and seated positioning system prescribed by a physician and required for use by the patient for a period of six (6) months or more. The following medicare wheelchair base codes are exempt: K0001, K0002, K0003, K0004, K0006, and K0007, as long as the consumer weighs less than three hundred pounds (300 lbs.).

[Acts 1947, ch. 13, §§ 2, 5, 14; mod. C. Supp. 1950, § 5879.1; Acts 1951, ch. 198, §§ 2, 3; 1953, ch. 113, § 26 (Williams, §§ 4432.2, 4432.5, 4432.14); Acts 1968, ch. 225, § 1; 1971, ch. 522, § 1; 1975, ch. 215, § 1; impl. am. Acts 1975, ch. 248, § 1; Acts 1975, ch. 276, § 1; 1976, ch. 471, § 1; 1978, ch. 930, § 1; 1979, ch. 77, § 1; 1981, ch. 397, § 1; T.C.A. (orig. ed.), § 53-1301; Acts 1984, ch. 880, §§ 1-3; 1985, ch. 88, §§ 1, 2; 1988, ch. 928, § 4; 1988, ch. 930, § 1; 1992, ch. 805, § 1; 1993, ch. 110, § 1; 1993, ch. 234, § 12; 1994, ch. 747, §§ 4-7; 1995, ch. 244, §§ 2-4; 1995, ch. 369, § 2; 1996, ch. 674, § 2; 1996, ch. 818, §§ 1, 2; 1998, ch. 869, §§ 1-3; 1998, ch. 1021, §§ 1-3; 1999, ch. 489, § 1; 2000, ch. 947, § 6; 2000, ch. 981, § 81; 2000, ch. 985, §§ 1, 2; 2001, ch. 272, §§ 1, 2; 2001, ch. 282, § 10; 2001, ch. 285, § 1; 2001, ch. 438, § 1; 2002, ch. 652, §§ 2-7; 2003, ch. 6, § 1; 2003, ch. 16, § 1; 2003, ch. 18, § 1; 2003, ch. 121, § 2; 2004, ch. 917, § 1; 2005, ch. 56, § 1; 2005, ch. 158, § 1; 2005, ch. 383, § 1; 2007, ch. 20, § 1; 2007, ch. 25, § 1; 2007, ch. 377, §§ 1, 2; 2008, ch. 764, §§ 1, 2; 2008, ch. 769, § 1; 2008, ch. 1190, §§ 21, 22; 2009, ch. 36, §§ 1, 2; 2009, ch. 186, § 50; 2009, ch. 579, § 2.]