{"identifier":"/us/usc/t42/s11151","title":42,"num":"\u00a7\u202f11151.","heading":"Definitions","text":"\u00a7\u202f11151.\nDefinitions\nIn this chapter:\n(1) The term \u201cadversely affecting\u201d includes reducing, restricting, suspending, revoking, denying, or failing to renew clinical privileges or membership in a health care entity.\n(2) The term \u201cBoard of Medical Examiners\u201d includes a body comparable to such a Board (as determined by the State) with responsibility for the licensing of physicians and also includes a subdivision of such a Board or body.\n(3) The term \u201cclinical privileges\u201d includes privileges, membership on the medical staff, and the other circumstances pertaining to the furnishing of medical care under which a physician or other licensed health care practitioner is permitted to furnish such care by a health care entity.\n(4)\n(A) The term \u201chealth care entity\u201d means\u2014\n(i) a hospital that is licensed to provide health care services by the State in which it is located,\n(ii) an entity (including a health maintenance organization or group medical practice) that provides health care services and that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the Secretary), and\n(iii) subject to subparagraph (B), a professional society (or committee thereof) of physicians or other licensed health care practitioners that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the Secretary).\n(B) The term \u201chealth care entity\u201d does not include a professional society (or committee thereof) if, within the previous 5 years, the society has been found by the Federal Trade Commission or any court to have engaged in any anti-competitive practice which had the effect of restricting the practice of licensed health care practitioners.\n(5) The term \u201chospital\u201d means an entity described in paragraphs (1) and (7) of\nsection 1395x(e) of this title\n(6) The terms \u201clicensed health care practitioner\u201d and \u201cpractitioner\u201d mean, with respect to a State, an individual (other than a physician) who is licensed or otherwise authorized by the State to provide health care services.\n(7) The term \u201cmedical malpractice action or claim\u201d means a written claim or demand for payment based on a health care provider\u2019s furnishing (or failure to furnish) health care services, and includes the filing of a cause of action, based on the law of tort, brought in any court of any State or the United States seeking monetary damages.\n(8) The term \u201cphysician\u201d means a doctor of medicine or osteopathy or a doctor of dental surgery or medical dentistry legally authorized to practice medicine and surgery or dentistry by a State (or any individual who, without authority holds himself or herself out to be so authorized).\n(9) The term \u201cprofessional review action\u201d means an action or recommendation of a professional review body which is taken or made in the conduct of professional review activity, which is based on the competence or professional conduct of an individual physician (which conduct affects or could affect adversely the health or welfare of a patient or patients), and which affects (or may affect) adversely the clinical privileges, or membership in a professional society, of the physician. Such term includes a formal decision of a professional review body not to take an action or make a recommendation described in the previous sentence and also includes professional review activities relating to a professional review action. In this chapter, an action is not considered to be based on the competence or professional conduct of a physician if the action is primarily based on\u2014\n(A) the physician\u2019s association, or lack of association, with a professional society or association,\n(B) the physician\u2019s fees or the physician\u2019s advertising or engaging in other competitive acts intended to solicit or retain business,\n(C) the physician\u2019s participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis,\n(D) a physician\u2019s association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care practitioner or professional, or\n(E) any other matter that does not relate to the competence or professional conduct of a physician.\n(10) The term \u201cprofessional review activity\u201d means an activity of a health care entity with respect to an individual physician\u2014\n(A) to determine whether the physician may have clinical privileges with respect to, or membership in, the entity,\n(B) to determine the scope or conditions of such privileges or membership, or\n(C) to change or modify such privileges or membership.\n(11) The term \u201cprofessional review body\u201d means a health care entity and the governing body or any committee of a health care entity which conducts professional review activity, and includes any committee of the medical staff of such an entity when assisting the governing body in a professional review activity.\n(12) The term \u201cSecretary\u201d means the Secretary of Health and Human Services.\n(13) The term \u201cState\u201d means the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.\n(14) The term \u201cState licensing board\u201d means, with respect to a physician or health care provider in a State, the agency of the State which is primarily responsible for the licensing of the physician or provider to furnish health care services.","url":"https://projectusc.org/usc/t42/s11151.html","content":[{"t":"sec","id":"/us/usc/t42/s11151","children":[{"t":"num","text":"\u00a7\u202f11151."},{"t":"heading","text":"Definitions","tail":"\n"},{"t":"chapeau","text":"In this chapter:"},{"t":"para","id":"/us/usc/t42/s11151/1","children":[{"t":"num","text":"(1)"},{"t":"content","text":" The term \u201cadversely affecting\u201d includes reducing, restricting, suspending, revoking, denying, or failing to renew clinical privileges or membership in a health care entity.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/2","children":[{"t":"num","text":"(2)"},{"t":"content","text":" The term \u201cBoard of Medical Examiners\u201d includes a body comparable to such a Board (as determined by the State) with responsibility for the licensing of physicians and also includes a subdivision of such a Board or body.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/3","children":[{"t":"num","text":"(3)"},{"t":"content","text":" The term \u201cclinical privileges\u201d includes privileges, membership on the medical staff, and the other circumstances pertaining to the furnishing of medical care under which a physician or other licensed health care practitioner is permitted to furnish such care by a health care entity.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/4","children":[{"t":"num","text":"(4)"},{"t":"subpara","id":"/us/usc/t42/s11151/4/A","children":[{"t":"num","text":"(A)"},{"t":"chapeau","text":" The term \u201chealth care entity\u201d means\u2014"},{"t":"clause","id":"/us/usc/t42/s11151/4/A/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" a hospital that is licensed to provide health care services by the State in which it is located,","tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s11151/4/A/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" an entity (including a health maintenance organization or group medical practice) that provides health care services and that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the Secretary), and","tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s11151/4/A/iii","children":[{"t":"num","text":"(iii)"},{"t":"content","text":" subject to subparagraph (B), a professional society (or committee thereof) of physicians or other licensed health care practitioners that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the Secretary).","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s11151/4/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" The term \u201chealth care entity\u201d does not include a professional society (or committee thereof) if, within the previous 5 years, the society has been found by the Federal Trade Commission or any court to have engaged in any anti-competitive practice which had the effect of restricting the practice of licensed health care practitioners.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/5","children":[{"t":"num","text":"(5)"},{"t":"content","text":" The term \u201chospital\u201d means an entity described in paragraphs (1) and (7) of ","children":[{"t":"ref","text":"section 1395x(e) of this title","href":"/us/usc/t42/s1395x/e","tail":"."}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/6","children":[{"t":"num","text":"(6)"},{"t":"content","text":" The terms \u201clicensed health care practitioner\u201d and \u201cpractitioner\u201d mean, with respect to a State, an individual (other than a physician) who is licensed or otherwise authorized by the State to provide health care services.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/7","children":[{"t":"num","text":"(7)"},{"t":"content","text":" The term \u201cmedical malpractice action or claim\u201d means a written claim or demand for payment based on a health care provider\u2019s furnishing (or failure to furnish) health care services, and includes the filing of a cause of action, based on the law of tort, brought in any court of any State or the United States seeking monetary damages.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/8","children":[{"t":"num","text":"(8)"},{"t":"content","text":" The term \u201cphysician\u201d means a doctor of medicine or osteopathy or a doctor of dental surgery or medical dentistry legally authorized to practice medicine and surgery or dentistry by a State (or any individual who, without authority holds himself or herself out to be so authorized).","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/9","children":[{"t":"num","text":"(9)"},{"t":"chapeau","text":" The term \u201cprofessional review action\u201d means an action or recommendation of a professional review body which is taken or made in the conduct of professional review activity, which is based on the competence or professional conduct of an individual physician (which conduct affects or could affect adversely the health or welfare of a patient or patients), and which affects (or may affect) adversely the clinical privileges, or membership in a professional society, of the physician. Such term includes a formal decision of a professional review body not to take an action or make a recommendation described in the previous sentence and also includes professional review activities relating to a professional review action. In this chapter, an action is not considered to be based on the competence or professional conduct of a physician if the action is primarily based on\u2014"},{"t":"subpara","id":"/us/usc/t42/s11151/9/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" the physician\u2019s association, or lack of association, with a professional society or association,","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s11151/9/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" the physician\u2019s fees or the physician\u2019s advertising or engaging in other competitive acts intended to solicit or retain business,","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s11151/9/C","children":[{"t":"num","text":"(C)"},{"t":"content","text":" the physician\u2019s participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis,","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s11151/9/D","children":[{"t":"num","text":"(D)"},{"t":"content","text":" a physician\u2019s association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care practitioner or professional, or","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s11151/9/E","children":[{"t":"num","text":"(E)"},{"t":"content","text":" any other matter that does not relate to the competence or professional conduct of a physician.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/10","children":[{"t":"num","text":"(10)"},{"t":"chapeau","text":" The term \u201cprofessional review activity\u201d means an activity of a health care entity with respect to an individual physician\u2014"},{"t":"subpara","id":"/us/usc/t42/s11151/10/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" to determine whether the physician may have clinical privileges with respect to, or membership in, the entity,","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s11151/10/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" to determine the scope or conditions of such privileges or membership, or","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s11151/10/C","children":[{"t":"num","text":"(C)"},{"t":"content","text":" to change or modify such privileges or membership.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/11","children":[{"t":"num","text":"(11)"},{"t":"content","text":" The term \u201cprofessional review body\u201d means a health care entity and the governing body or any committee of a health care entity which conducts professional review activity, and includes any committee of the medical staff of such an entity when assisting the governing body in a professional review activity.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/12","children":[{"t":"num","text":"(12)"},{"t":"content","text":" The term \u201cSecretary\u201d means the Secretary of Health and Human Services.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/13","children":[{"t":"num","text":"(13)"},{"t":"content","text":" The term \u201cState\u201d means the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s11151/14","children":[{"t":"num","text":"(14)"},{"t":"content","text":" The term \u201cState licensing board\u201d means, with respect to a physician or health care provider in a State, the agency of the State which is primarily responsible for the licensing of the physician or provider to furnish health care services.","tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"}]}]}