{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-276.3.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-276.3.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-276.3.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-276.3.html"}],"law_id":67276,"edition_id":1,"section_id":67276,"structure_id":14841,"section_number":"32.1-276.3","catch_line":"Definitions","history":"1996, cc. 902, 905, 1046; 1999, c. 764; 2000, cc. 720, 897; 2001, c. 341; 2003, c. 466; 2009, cc. 813, 840; 2019, cc. 672, 673.","full_text":"As used in this chapter:\n\t\t“Actual reimbursement amount” means reimbursement information included in the claims data submitted by data suppliers to the Virginia All-Payer Claims Database, whether such information is referred to in the claims data as “paid amounts,” “allowed amounts,” or another term having the same or similar meaning and whether in reference to the payer who paid the actual reimbursement amount or the provider who received the actual reimbursement amount.\n\t\t“Board” means the Board of Health.\n\t\t“Common data layout” means the national data collection standard adopted and maintained by the APCD Council.\n\t\t“Consumer” means any person (i) whose occupation is other than the administration of health activities or the provision of health services, (ii) who has no fiduciary obligation to a health care institution or other health agency or to any organization, public or private, whose principal activity is an adjunct to the provision of health services, or (iii) who has no material financial interest in the rendering of health services.\n\t\t“Covered lives” means subscribers, policyholders, members, enrollees, or dependents, as the case may be, under a policy or contract issued or issued for delivery in Virginia by a managed care health insurance plan licensee, insurer, health services plan, or preferred provider organization.\n\t\t“ERISA plan” means any self-funded employee welfare benefit plan governed by the requirements of the Employee Retirement Income Security Act of 1974, 29 U.S.C. \u00a7 1002(1).\n\t\t“Health care provider” means (i) a general hospital, ordinary hospital, outpatient surgical hospital, nursing home or certified nursing facility licensed or certified pursuant to Article 1 (\u00a7 32.1-123 et seq.) of Chapter 5 of this title; (ii) a mental or psychiatric hospital licensed pursuant to Article 2 (\u00a7 37.2-403 et seq.) of Chapter 4 of Title 37.2; (iii) a hospital operated by the Department of Behavioral Health and Developmental Services; (iv) a hospital operated by the University of Virginia or the Virginia Commonwealth University Health System Authority; (v) any person licensed to practice medicine or osteopathy in the Commonwealth pursuant to Chapter 29 (\u00a7 54.1-2900 et seq.) of Title 54.1; (vi) any person licensed to furnish health care policies or plans pursuant to Chapter 34 (\u00a7 38.2-3400 et seq.), Chapter 42 (\u00a7 38.2-4200), or Chapter 43 (\u00a7 38.2-4300) of Title 38.2; or (vii) any person licensed to practice dentistry pursuant to Chapter 27 (\u00a7 54.1-2700 et seq.) of Title 54.1 who is registered with the Board of Dentistry as an oral and maxillofacial surgeon and certified by the Board of Dentistry to perform certain procedures pursuant to \u00a7 54.1-2709.1. In no event shall such term be construed to include continuing care retirement communities which file annual financial reports with the State Corporation Commission pursuant to Chapter 49 (\u00a7 38.2-4900 et seq.) of Title 38.2 or any nursing care facility of a religious body which depends upon prayer alone for healing.\n\t\t“Health maintenance organization” means any person who undertakes to provide or to arrange for one or more health care plans pursuant to Chapter 43 (\u00a7 38.2-4300 et seq.) of Title 38.2.\n\t\t“Inpatient hospital” means a hospital providing inpatient care and licensed pursuant to Article 1 (\u00a7 32.1-123 et seq.) of Chapter 5, a hospital licensed pursuant to Article 2 (\u00a7 37.2-403 et seq.) of Chapter 4 of Title 37.2, a hospital operated by the Department of Behavioral Health and Developmental Services for the care and treatment of individuals with mental illness, or a hospital operated by the University of Virginia or the Virginia Commonwealth University Health System Authority.\n\t\t“Nonprofit organization” means a nonprofit, tax-exempt health data organization with the characteristics, expertise, and capacity to execute the powers and duties set forth for such entity in this chapter.\n\t\t“Oral and maxillofacial surgeon” means, for the purposes of this chapter, a person who is licensed to practice dentistry in Virginia, registered with the Board of Dentistry as an oral and maxillofacial surgeon, and certified to perform certain procedures pursuant to \u00a7 54.1-2709.1.\n\t\t“Oral and maxillofacial surgeon’s office” means a place (i) owned or operated by a licensed and registered oral and maxillofacial surgeon who is certified to perform certain procedures pursuant to \u00a7 54.1-2709.1 or by a group of oral and maxillofacial surgeons, at least one of whom is so certified, practicing in any legal form whatsoever or by a corporation, partnership, limited liability company or other entity that employs or engages at least one oral and maxillofacial surgeon who is so certified, and (ii) designed and equipped for the provision of oral and maxillofacial surgery services to ambulatory patients.\n\t\t“Outpatient surgery” means all surgical procedures performed on an outpatient basis in a general hospital, ordinary hospital, outpatient surgical hospital or other facility licensed or certified pursuant to Article 1 (\u00a7 32.1-123 et seq.) of Chapter 5 of this title or in a physician’s office or oral and maxillofacial surgeon’s office, as defined above. Outpatient surgery refers only to those surgical procedure groups on which data are collected by the nonprofit organization as a part of a pilot study.\n\t\t“Physician” means a person licensed to practice medicine or osteopathy in the Commonwealth pursuant to Chapter 29 (\u00a7 54.1-2900 et seq.) of Title 54.1.\n\t\t“Physician’s office” means a place (i) owned or operated by a licensed physician or group of physicians practicing in any legal form whatsoever or by a corporation, partnership, limited liability company or other entity that employs or engages physicians and (ii) designed and equipped solely for the provision of fundamental medical care, whether diagnostic, therapeutic, rehabilitative, preventive or palliative, to ambulatory patients.\n\t\t“Surgical procedure group” means at least five procedure groups, identified by the nonprofit organization designated pursuant to \u00a7 32.1-276.4 in compliance with regulations adopted by the Board, based on criteria that include, but are not limited to, the frequency with which the procedure is performed, the clinical severity or intensity, and the perception or probability of risk. The nonprofit organization shall form a technical advisory group consisting of members nominated by its Board of Directors’ nominating organizations to assist in selecting surgical procedure groups to recommend to the Board for adoption.\n\t\t“System” means the Virginia Patient Level Data System.","order_by":null,"text":{"0":{"id":243823,"text":"As used in this chapter:\n\t\t“Actual reimbursement amount” means reimbursement information included in the claims data submitted by data suppliers to the Virginia All-Payer Claims Database, whether such information is referred to in the claims data as “paid amounts,” “allowed amounts,” or another term having the same or similar meaning and whether in reference to the payer who paid the actual reimbursement amount or the provider who received the actual reimbursement amount.\n\t\t“Board” means the Board of Health.\n\t\t“Common data layout” means the national data collection standard adopted and maintained by the APCD Council.\n\t\t“Consumer” means any person (i) whose occupation is other than the administration of health activities or the provision of health services, (ii) who has no fiduciary obligation to a health care institution or other health agency or to any organization, public or private, whose principal activity is an adjunct to the provision of health services, or (iii) who has no material financial interest in the rendering of health services.\n\t\t“Covered lives” means subscribers, policyholders, members, enrollees, or dependents, as the case may be, under a policy or contract issued or issued for delivery in Virginia by a managed care health insurance plan licensee, insurer, health services plan, or preferred provider organization.\n\t\t“ERISA plan” means any self-funded employee welfare benefit plan governed by the requirements of the Employee Retirement Income Security Act of 1974, 29 U.S.C. \u00a7 1002(1).\n\t\t“Health care provider” means (i) a general hospital, ordinary hospital, outpatient surgical hospital, nursing home or certified nursing facility licensed or certified pursuant to Article 1 (\u00a7 32.1-123 et seq.) of Chapter 5 of this title; (ii) a mental or psychiatric hospital licensed pursuant to Article 2 (\u00a7 37.2-403 et seq.) of Chapter 4 of Title 37.2; (iii) a hospital operated by the Department of Behavioral Health and Developmental Services; (iv) a hospital operated by the University of Virginia or the Virginia Commonwealth University Health System Authority; (v) any person licensed to practice medicine or osteopathy in the Commonwealth pursuant to Chapter 29 (\u00a7 54.1-2900 et seq.) of Title 54.1; (vi) any person licensed to furnish health care policies or plans pursuant to Chapter 34 (\u00a7 38.2-3400 et seq.), Chapter 42 (\u00a7 38.2-4200), or Chapter 43 (\u00a7 38.2-4300) of Title 38.2; or (vii) any person licensed to practice dentistry pursuant to Chapter 27 (\u00a7 54.1-2700 et seq.) of Title 54.1 who is registered with the Board of Dentistry as an oral and maxillofacial surgeon and certified by the Board of Dentistry to perform certain procedures pursuant to \u00a7 54.1-2709.1. In no event shall such term be construed to include continuing care retirement communities which file annual financial reports with the State Corporation Commission pursuant to Chapter 49 (\u00a7 38.2-4900 et seq.) of Title 38.2 or any nursing care facility of a religious body which depends upon prayer alone for healing.\n\t\t“Health maintenance organization” means any person who undertakes to provide or to arrange for one or more health care plans pursuant to Chapter 43 (\u00a7 38.2-4300 et seq.) of Title 38.2.\n\t\t“Inpatient hospital” means a hospital providing inpatient care and licensed pursuant to Article 1 (\u00a7 32.1-123 et seq.) of Chapter 5, a hospital licensed pursuant to Article 2 (\u00a7 37.2-403 et seq.) of Chapter 4 of Title 37.2, a hospital operated by the Department of Behavioral Health and Developmental Services for the care and treatment of individuals with mental illness, or a hospital operated by the University of Virginia or the Virginia Commonwealth University Health System Authority.\n\t\t“Nonprofit organization” means a nonprofit, tax-exempt health data organization with the characteristics, expertise, and capacity to execute the powers and duties set forth for such entity in this chapter.\n\t\t“Oral and maxillofacial surgeon” means, for the purposes of this chapter, a person who is licensed to practice dentistry in Virginia, registered with the Board of Dentistry as an oral and maxillofacial surgeon, and certified to perform certain procedures pursuant to \u00a7 54.1-2709.1.\n\t\t“Oral and maxillofacial surgeon’s office” means a place (i) owned or operated by a licensed and registered oral and maxillofacial surgeon who is certified to perform certain procedures pursuant to \u00a7 54.1-2709.1 or by a group of oral and maxillofacial surgeons, at least one of whom is so certified, practicing in any legal form whatsoever or by a corporation, partnership, limited liability company or other entity that employs or engages at least one oral and maxillofacial surgeon who is so certified, and (ii) designed and equipped for the provision of oral and maxillofacial surgery services to ambulatory patients.\n\t\t“Outpatient surgery” means all surgical procedures performed on an outpatient basis in a general hospital, ordinary hospital, outpatient surgical hospital or other facility licensed or certified pursuant to Article 1 (\u00a7 32.1-123 et seq.) of Chapter 5 of this title or in a physician’s office or oral and maxillofacial surgeon’s office, as defined above. Outpatient surgery refers only to those surgical procedure groups on which data are collected by the nonprofit organization as a part of a pilot study.\n\t\t“Physician” means a person licensed to practice medicine or osteopathy in the Commonwealth pursuant to Chapter 29 (\u00a7 54.1-2900 et seq.) of Title 54.1.\n\t\t“Physician’s office” means a place (i) owned or operated by a licensed physician or group of physicians practicing in any legal form whatsoever or by a corporation, partnership, limited liability company or other entity that employs or engages physicians and (ii) designed and equipped solely for the provision of fundamental medical care, whether diagnostic, therapeutic, rehabilitative, preventive or palliative, to ambulatory patients.\n\t\t“Surgical procedure group” means at least five procedure groups, identified by the nonprofit organization designated pursuant to \u00a7 32.1-276.4 in compliance with regulations adopted by the Board, based on criteria that include, but are not limited to, the frequency with which the procedure is performed, the clinical severity or intensity, and the perception or probability of risk. The nonprofit organization shall form a technical advisory group consisting of members nominated by its Board of Directors’ nominating organizations to assist in selecting surgical procedure groups to recommend to the Board for adoption.\n\t\t“System” means the Virginia Patient Level Data System.","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1}},"ancestry":[{"id":14841,"edition_id":1,"name":"Health Care Data Reporting","identifier":"7.2","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:50:19","date_modified":"2026-06-26 03:50:19","permalink":{"id":204329,"object_type":"structure","relational_id":14841,"identifier":"7.2","token":"32.1\/7.2","url":"\/32.1\/7.2\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":79337,"structure_id":14841,"section_number":"32.1-276.10","catch_line":"Chapter and actions thereunder not to be construed as approval of charges or costs","url":"\/32.1-276.10\/","token":"32.1\/7.2\/32.1-276.10","metadata":false},{"id":68729,"structure_id":14841,"section_number":"32.1-276.11","catch_line":"Violations","url":"\/32.1-276.11\/","token":"32.1\/7.2\/32.1-276.11","metadata":false},{"id":71744,"structure_id":14841,"section_number":"32.1-276.2","catch_line":"Health care data reporting; purpose","url":"\/32.1-276.2\/","token":"32.1\/7.2\/32.1-276.2","metadata":false},{"id":67276,"structure_id":14841,"section_number":"32.1-276.3","catch_line":"Definitions","url":"\/32.1-276.3\/","token":"32.1\/7.2\/32.1-276.3","metadata":false},{"id":56739,"structure_id":14841,"section_number":"32.1-276.4","catch_line":"Agreements for certain data services","url":"\/32.1-276.4\/","token":"32.1\/7.2\/32.1-276.4","metadata":false},{"id":84829,"structure_id":14841,"section_number":"32.1-276.5","catch_line":"Providers to submit data; civil penalty","url":"\/32.1-276.5\/","token":"32.1\/7.2\/32.1-276.5","metadata":false},{"id":62565,"structure_id":14841,"section_number":"32.1-276.5:1","catch_line":"Repealed","url":"\/32.1-276.5_1\/","token":"32.1\/7.2\/32.1-276.5_1","metadata":false},{"id":77566,"structure_id":14841,"section_number":"32.1-276.6","catch_line":"Patient level data system continued; reporting requirements","url":"\/32.1-276.6\/","token":"32.1\/7.2\/32.1-276.6","metadata":false},{"id":67668,"structure_id":14841,"section_number":"32.1-276.7","catch_line":"Methodology to review and measure the efficiency and productivity of health care providers","url":"\/32.1-276.7\/","token":"32.1\/7.2\/32.1-276.7","metadata":false},{"id":85887,"structure_id":14841,"section_number":"32.1-276.7:1","catch_line":"All-Payer Claims Database created; purpose; reporting requirements","url":"\/32.1-276.7_1\/","token":"32.1\/7.2\/32.1-276.7_1","metadata":false},{"id":73124,"structure_id":14841,"section_number":"32.1-276.8","catch_line":"Fees for processing, verification, and dissemination of data","url":"\/32.1-276.8\/","token":"32.1\/7.2\/32.1-276.8","metadata":false},{"id":80143,"structure_id":14841,"section_number":"32.1-276.9","catch_line":"Confidentiality, subsequent release of data and relief from liability for reporting; penalty for wrongful disclosure; individual action for damages","url":"\/32.1-276.9\/","token":"32.1\/7.2\/32.1-276.9","metadata":false},{"id":81074,"structure_id":14841,"section_number":"32.1-276.9:1","catch_line":"Health information needs related to reform; work group","url":"\/32.1-276.9_1\/","token":"32.1\/7.2\/32.1-276.9_1","metadata":false}],"previous_section":{"id":71744,"structure_id":14841,"section_number":"32.1-276.2","catch_line":"Health care data reporting; purpose","url":"\/32.1-276.2\/","token":"32.1\/7.2\/32.1-276.2","metadata":false},"next_section":{"id":56739,"structure_id":14841,"section_number":"32.1-276.4","catch_line":"Agreements for certain data services","url":"\/32.1-276.4\/","token":"32.1\/7.2\/32.1-276.4","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-276.3\/","history_text":"

This law was first created in 1996. The record of its establishment is cataloged in chapters 902<\/a>, 905<\/a>, and 1046<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 6 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1999, chapter 764<\/a>; in 2000, chapters 720<\/a> and 897<\/a>; in 2001, chapter 341<\/a>; in 2003, chapter 466<\/a>; in 2009, chapters 813<\/a> and 840<\/a>; in 2019, chapters 672<\/a> and 673<\/a>.<\/p>","references":[{"id":77566,"section_number":"32.1-276.6","catch_line":"Patient level data system continued; reporting requirements","order_by":null,"url":"\/32.1-276.6\/"},{"id":67668,"section_number":"32.1-276.7","catch_line":"Methodology to review and measure the efficiency and productivity of health care providers","order_by":null,"url":"\/32.1-276.7\/"},{"id":72064,"section_number":"54.1-3300","catch_line":"Definitions","order_by":null,"url":"\/54.1-3300\/"},{"id":77902,"section_number":"54.1-3300.1","catch_line":"Participation in collaborative agreements; regulations to be promulgated by the Boards of Medicine and Pharmacy","order_by":null,"url":"\/54.1-3300.1\/"},{"id":81398,"section_number":"59.1-575","catch_line":"(Effective January 1, 2026) Definitions","order_by":null,"url":"\/59.1-575\/"}],"refers_to":[{"id":80727,"section_number":"32.1-123","catch_line":"(Effective January 1, 2026) Definitions","order_by":null,"url":"\/32.1-123\/"},{"id":56739,"section_number":"32.1-276.4","catch_line":"Agreements for certain data services","order_by":null,"url":"\/32.1-276.4\/"},{"id":60864,"section_number":"37.2-403","catch_line":"Definitions","order_by":null,"url":"\/37.2-403\/"},{"id":57593,"section_number":"38.2-3400","catch_line":"Application of chapter","order_by":null,"url":"\/38.2-3400\/"},{"id":78890,"section_number":"38.2-4200","catch_line":"Applicability of chapter","order_by":null,"url":"\/38.2-4200\/"},{"id":72005,"section_number":"38.2-4300","catch_line":"Definitions","order_by":null,"url":"\/38.2-4300\/"},{"id":83470,"section_number":"38.2-4900","catch_line":"Definitions","order_by":null,"url":"\/38.2-4900\/"},{"id":80904,"section_number":"54.1-2700","catch_line":"Definitions","order_by":null,"url":"\/54.1-2700\/"},{"id":54080,"section_number":"54.1-2709.1","catch_line":"Certain certification required","order_by":null,"url":"\/54.1-2709.1\/"},{"id":63078,"section_number":"54.1-2900","catch_line":"Definitions","order_by":null,"url":"\/54.1-2900\/"}],"permalink":{"id":204343,"object_type":"law","relational_id":67276,"identifier":"32.1-276.3","token":"32.1\/7.2\/32.1-276.3","url":"\/32.1-276.3\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-276.3\/","token":"32.1\/7.2\/32.1-276.3","dublin_core":{"Title":"Definitions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-276.3","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

As used in this chapter:\n\t\t“Actual reimbursement amount<\/span>” means reimbursement information included in the claims data submitted by data suppliers to the Virginia All-Payer Claims Database, whether such information is referred to in the claims data as “paid amounts,” “allowed amounts,” or another term having the same or similar meaning and whether in reference to the payer who paid the actual reimbursement amount<\/span> or the provider who received the actual reimbursement amount<\/span>.\n\t\t“Board<\/span>” means the Board<\/span> of Health.\n\t\t“Common data layout<\/span>” means the national data collection standard adopted and maintained by the APCD Council.\n\t\t“Consumer<\/span>” means any person<\/span> (i) whose occupation is other than the administration of health activities or the provision of health services, (ii) who has no fiduciary obligation to a health care institution or other health agency or to any organization, public or private, whose principal activity is an adjunct to the provision of health services, or (iii) who has no material<\/span> financial interest in the rendering of health services.\n\t\t“Covered lives<\/span>” means subscribers, policyholders, members, enrollees, or dependents, as the case may be, under a policy or contract<\/span> issued or issued for delivery in Virginia by a managed care health insurance plan licensee, insurer, health services plan, or preferred provider organization.\n\t\t“ERISA plan<\/span>” means any self-funded employee welfare benefit plan governed by the requirements of the Employee Retirement Income Security Act of 1974, 29 U.S.C. \u00a7 1002(1).\n\t\t“Health care provider<\/span>” means (i) a general hospital, ordinary hospital, outpatient surgical hospital, nursing home or certified nursing facility licensed or certified pursuant to Article 1 (\u00a7 32.1-123<\/a> et seq.) of Chapter 5 of this title; (ii) a mental or psychiatric hospital licensed pursuant to Article 2 (\u00a7 37.2-403<\/a> et seq.) of Chapter 4 of Title 37.2; (iii) a hospital operated by the Department<\/span> of Behavioral Health and Developmental Services; (iv) a hospital operated by the University of Virginia or the Virginia Commonwealth University Health System<\/span> Authority; (v) any person<\/span> licensed to practice medicine or osteopathy in the Commonwealth pursuant to Chapter 29 (\u00a7 54.1-2900<\/a> et seq.) of Title 54.1; (vi) any person<\/span> licensed to furnish health care policies or plans pursuant to Chapter 34 (\u00a7 38.2-3400<\/a> et seq.), Chapter 42 (\u00a7 38.2-4200<\/a>), or Chapter 43 (\u00a7 38.2-4300<\/a>) of Title 38.2; or (vii) any person<\/span> licensed to practice dentistry pursuant to Chapter 27 (\u00a7 54.1-2700<\/a> et seq.) of Title 54.1 who is registered with the Board<\/span> of Dentistry as an oral and maxillofacial surgeon and certified by the Board<\/span> of Dentistry to perform certain procedures pursuant to \u00a7 54.1-2709.1<\/a>. In no event shall such term be construed to include continuing care retirement communities which file annual financial reports with the State Corporation Commission pursuant to Chapter 49 (\u00a7 38.2-4900<\/a> et seq.) of Title 38.2 or any nursing care facility of a religious body which depends upon prayer alone for healing.\n\t\t“Health maintenance organization<\/span>” means any person<\/span> who undertakes to provide or to arrange for one or more health care plans pursuant to Chapter 43 (\u00a7 38.2-4300<\/a> et seq.) of Title 38.2.\n\t\t“Inpatient hospital<\/span>” means a hospital providing inpatient care and licensed pursuant to Article 1 (\u00a7 32.1-123<\/a> et seq.) of Chapter 5, a hospital licensed pursuant to Article 2 (\u00a7 37.2-403<\/a> et seq.) of Chapter 4 of Title 37.2, a hospital operated by the Department<\/span> of Behavioral Health and Developmental Services for the care and treatment of individuals with mental illness, or a hospital operated by the University of Virginia or the Virginia Commonwealth University Health System<\/span> Authority.\n\t\t“Nonprofit organization<\/span>” means a nonprofit, tax-exempt health data organization with the characteristics, expertise, and capacity to execute the powers and duties set forth for such entity in this chapter.\n\t\t“Oral and maxillofacial surgeon” means, for the purposes of this chapter, a person<\/span> who is licensed to practice dentistry in Virginia, registered with the Board<\/span> of Dentistry as an oral and maxillofacial surgeon, and certified to perform certain procedures pursuant to \u00a7 54.1-2709.1<\/a>.\n\t\t“Oral and maxillofacial surgeon’s office” means a place (i) owned or operated by a licensed and registered oral and maxillofacial surgeon who is certified to perform certain procedures pursuant to \u00a7 54.1-2709.1<\/a> or by a group of oral and maxillofacial surgeons, at least one of whom is so certified, practicing in any legal form whatsoever or by a corporation, partnership, limited liability company or other entity that employs or engages at least one oral and maxillofacial surgeon who is so certified, and (ii) designed and equipped for the provision of oral and maxillofacial surgery services to ambulatory patients.\n\t\t“Outpatient surgery<\/span>” means all surgical procedures performed on an outpatient basis in a general hospital, ordinary hospital, outpatient surgical hospital or other facility licensed or certified pursuant to Article 1 (\u00a7 32.1-123<\/a> et seq.) of Chapter 5 of this title or in a physician<\/span>’s office or oral and maxillofacial surgeon’s office, as defined above. Outpatient surgery<\/span> refers only to those surgical procedure groups<\/span> on which data are collected by the nonprofit organization<\/span> as a part of a pilot study.\n\t\t“Physician<\/span>” means a person<\/span> licensed to practice medicine or osteopathy in the Commonwealth pursuant to Chapter 29 (\u00a7 54.1-2900<\/a> et seq.) of Title 54.1.\n\t\t“Physician<\/span>’s office” means a place (i) owned or operated by a licensed physician<\/span> or group of physicians<\/span> practicing in any legal form whatsoever or by a corporation, partnership, limited liability company or other entity that employs or engages physicians<\/span> and (ii) designed and equipped solely for the provision of fundamental medical care, whether diagnostic, therapeutic, rehabilitative, preventive or palliative, to ambulatory patients.\n\t\t“Surgical procedure group<\/span>” means at least five procedure groups, identified by the nonprofit organization<\/span> designated pursuant to \u00a7 32.1-276.4<\/a> in compliance with regulations adopted by the Board<\/span>, based on criteria that include, but are not limited to, the frequency with which the procedure is performed, the clinical severity or intensity, and the perception or probability of risk. The nonprofit organization<\/span> shall form a technical advisory group consisting of members nominated by its Board<\/span> of Directors’ nominating organizations to assist in selecting surgical procedure groups<\/span> to recommend to the Board<\/span> for adoption.\n\t\t“System<\/span>” means the Virginia Patient Level Data System<\/span>.<\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDEFINITIONS (\u00a7 32.1-276.3)\n\nAs used in this chapter:\n\t\t“Actual reimbursement amount” means reimbursement information\nincluded in the claims data submitted by data suppliers to the Virginia\nAll-Payer Claims Database, whether such information is referred to in the claims\ndata as “paid amounts,” “allowed amounts,” or another\nterm having the same or similar meaning and whether in reference to the payer\nwho paid the actual reimbursement amount or the provider who received the actual\nreimbursement amount.\n\t\t“Board” means the Board of Health.\n\t\t“Common data layout” means the national data collection standard\nadopted and maintained by the APCD Council.\n\t\t“Consumer” means any person (i) whose occupation is other than the\nadministration of health activities or the provision of health services, (ii)\nwho has no fiduciary obligation to a health care institution or other health\nagency or to any organization, public or private, whose principal activity is an\nadjunct to the provision of health services, or (iii) who has no material\nfinancial interest in the rendering of health services.\n\t\t“Covered lives” means subscribers, policyholders, members,\nenrollees, or dependents, as the case may be, under a policy or contract issued\nor issued for delivery in Virginia by a managed care health insurance plan\nlicensee, insurer, health services plan, or preferred provider organization.\n\t\t“ERISA plan” means any self-funded employee welfare benefit plan\ngoverned by the requirements of the Employee Retirement Income Security Act of\n1974, 29 U.S.C. \u00a7 1002(1).\n\t\t“Health care provider” means (i) a general hospital, ordinary\nhospital, outpatient surgical hospital, nursing home or certified nursing\nfacility licensed or certified pursuant to Article 1 (\u00a7 32.1-123 et seq.) of\nChapter 5 of this title; (ii) a mental or psychiatric hospital licensed pursuant\nto Article 2 (\u00a7 37.2-403 et seq.) of Chapter 4 of Title 37.2; (iii) a hospital\noperated by the Department of Behavioral Health and Developmental Services; (iv)\na hospital operated by the University of Virginia or the Virginia Commonwealth\nUniversity Health System Authority; (v) any person licensed to practice medicine\nor osteopathy in the Commonwealth pursuant to Chapter 29 (\u00a7 54.1-2900 et seq.)\nof Title 54.1; (vi) any person licensed to furnish health care policies or plans\npursuant to Chapter 34 (\u00a7 38.2-3400 et seq.), Chapter 42 (\u00a7 38.2-4200), or\nChapter 43 (\u00a7 38.2-4300) of Title 38.2; or (vii) any person licensed to\npractice dentistry pursuant to Chapter 27 (\u00a7 54.1-2700 et seq.) of Title 54.1\nwho is registered with the Board of Dentistry as an oral and maxillofacial\nsurgeon and certified by the Board of Dentistry to perform certain procedures\npursuant to \u00a7 54.1-2709.1. In no event shall such term be construed to include\ncontinuing care retirement communities which file annual financial reports with\nthe State Corporation Commission pursuant to Chapter 49 (\u00a7 38.2-4900 et seq.)\nof Title 38.2 or any nursing care facility of a religious body which depends\nupon prayer alone for healing.\n\t\t“Health maintenance organization” means any person who undertakes\nto provide or to arrange for one or more health care plans pursuant to Chapter\n43 (\u00a7 38.2-4300 et seq.) of Title 38.2.\n\t\t“Inpatient hospital” means a hospital providing inpatient care and\nlicensed pursuant to Article 1 (\u00a7 32.1-123 et seq.) of Chapter 5, a hospital\nlicensed pursuant to Article 2 (\u00a7 37.2-403 et seq.) of Chapter 4 of Title 37.2,\na hospital operated by the Department of Behavioral Health and Developmental\nServices for the care and treatment of individuals with mental illness, or a\nhospital operated by the University of Virginia or the Virginia Commonwealth\nUniversity Health System Authority.\n\t\t“Nonprofit organization” means a nonprofit, tax-exempt health data\norganization with the characteristics, expertise, and capacity to execute the\npowers and duties set forth for such entity in this chapter.\n\t\t“Oral and maxillofacial surgeon” means, for the purposes of this\nchapter, a person who is licensed to practice dentistry in Virginia, registered\nwith the Board of Dentistry as an oral and maxillofacial surgeon, and certified\nto perform certain procedures pursuant to \u00a7 54.1-2709.1.\n\t\t“Oral and maxillofacial surgeon’s office” means a place (i)\nowned or operated by a licensed and registered oral and maxillofacial surgeon\nwho is certified to perform certain procedures pursuant to \u00a7 54.1-2709.1 or by\na group of oral and maxillofacial surgeons, at least one of whom is so\ncertified, practicing in any legal form whatsoever or by a corporation,\npartnership, limited liability company or other entity that employs or engages\nat least one oral and maxillofacial surgeon who is so certified, and (ii)\ndesigned and equipped for the provision of oral and maxillofacial surgery\nservices to ambulatory patients.\n\t\t“Outpatient surgery” means all surgical procedures performed on an\noutpatient basis in a general hospital, ordinary hospital, outpatient surgical\nhospital or other facility licensed or certified pursuant to Article 1 (\u00a7\n32.1-123 et seq.) of Chapter 5 of this title or in a physician’s office or\noral and maxillofacial surgeon’s office, as defined above. Outpatient\nsurgery refers only to those surgical procedure groups on which data are\ncollected by the nonprofit organization as a part of a pilot study.\n\t\t“Physician” means a person licensed to practice medicine or\nosteopathy in the Commonwealth pursuant to Chapter 29 (\u00a7 54.1-2900 et seq.) of\nTitle 54.1.\n\t\t“Physician’s office” means a place (i) owned or operated by\na licensed physician or group of physicians practicing in any legal form\nwhatsoever or by a corporation, partnership, limited liability company or other\nentity that employs or engages physicians and (ii) designed and equipped solely\nfor the provision of fundamental medical care, whether diagnostic, therapeutic,\nrehabilitative, preventive or palliative, to ambulatory patients.\n\t\t“Surgical procedure group” means at least five procedure groups,\nidentified by the nonprofit organization designated pursuant to \u00a7 32.1-276.4 in\ncompliance with regulations adopted by the Board, based on criteria that\ninclude, but are not limited to, the frequency with which the procedure is\nperformed, the clinical severity or intensity, and the perception or probability\nof risk. The nonprofit organization shall form a technical advisory group\nconsisting of members nominated by its Board of Directors’ nominating\norganizations to assist in selecting surgical procedure groups to recommend to\nthe Board for adoption.\n\t\t“System” means the Virginia Patient Level Data System.\n\nHISTORY: 1996, cc. 902, 905, 1046; 1999, c. 764; 2000, cc. 720, 897; 2001, c.\n341; 2003, c. 466; 2009, cc. 813, 840; 2019, cc. 672, 673.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}