[§334B-2]  Definitions.  As usedin this chapter:

“Director” means the director of health.

“Health care provider” means any person,corporation, facility, or institution licensed by this State to provide healthcare services, including but not limited to a physician, hospital or otherhealth care facility, nurse, psychologist, or substance abuse counselor, andofficer, employee, or agent of such provider acting in the course and scope ofemployment or agency related to health care services.

“Health care services” means diagnosis,treatment, medical or psychological evaluation or advice, or other acts aspermissible under the health care licensing statutes of this State.

“Physician” means a person licensed to practicemedicine under chapter 453.

“Psychologist” means a person licensed topractice psychology under chapter 465.

“Review agent” means a hospital ornonhospital-affiliated person or entity performing utilization review ormanaged care that is either affiliated with, under contract with, or acting onbehalf of:

(1)  A business entity in this State; or

(2)  A third party that provides or administershospital, medical, psychological, or other health care benefits to citizens ofthis State, including a health insurer, nonprofit health service plan, healthinsurance service organization, health maintenance organization, or preferredprovider organization authorized to offer health insurance policies orcontracts in this State.

“Utilization review” or “managed care” means asystem for reviewing the appropriate and efficient allocation of mental health,alcohol, or drug abuse treatment services given or proposed to be given to apatient or group of patients for the purpose of recommending or determiningwhether such services should be reimbursed, covered, or provided by an insurer,plan or other entity or person.

“Utilization review plan” means a descriptionof the criteria and standards governing utilization review or managed careactivities performed by a review agent. [L 1991, c 95, pt of §1]