1.16 (R) [INFO] Topic 3. Healthcare Organization Definitions
Topic 3. Which organizations are considered healthcare organizations in the United States? At first glance, one might think there is an easy and obvious answer to this question. Defining a healthcare organization should be straightforward. However, there may be differences of opinion between reasonable people regarding an organization's category/definition. Some may be of the opinion, for example, that fitness centers are healthcare organizations. Some would say they are not, unless, perhaps, that fitness center was located in a hospital and could be used only upon a doctor's order. There are, however, laws and regulations which categorize/define organizations for different purposes. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson One Quiz. Below is a summary of which organizations are defined as a healthcare organization by some of the most commonly used laws/regulations. Each of these laws/regulations is discussed in more detail in additional content sections associated with this question. A healthcare organization, therefore, can be defined as any organization: Requiring regulation and licensing by a state as a health facility. Meeting the definition of a health care provider as defined in the Code of Federal Regulations (CFR) used by Health and Human Services (HHS). Having a National Provider Identifier (NPI) number assigned by HHS Centers for Medicare and Medicaid Services (CMS). Certified by CMS (Medicare-certified, CMS-certified). Classified in the North American Industry Classification System (NAICS) in subsector 621, 622, or 623. Classified in NAICS in subsector 621, 622, or 623 or one of the other subsectors with a classification title including the word “health” (e.g., 44611, 532283).
Definition 1. A healthcare organization can be defined as any organization requiring regulation and licensing by a state as a health facility. Most states regulate healthcare facilities (organizations). For example, The State of New Jersey Department of Health (NJDOH) regulates and licenses more than 2000 hospitals, outpatient facilities, and long term care facilities in New Jersey. A healthcare organization in any given state is an organization requiring regulation and licensing in that state as a health facility. It should be noted that some states license a healthcare provider as an individual, but not the organization within which that provider works. For example, New Jersey does not license dental offices (organizations), but does regulate and license dentists through the New Jersey Division of Consumer Affairs, Boards and Committees - State Board of Dentistry. Physicians are regulated and licensed by the New Jersey Division of Consumer Affairs, State Board of Medical Examiners. Nurses are regulated and licensed by the New Jersey Division of Consumer Affairs, State Board of Nursing. The requirements for regulation and licensing for any healthcare provider profession may vary by state. Two good examples are the fields of nutrition and dietetics. The Center for Nutrition Advocacy provides information on licensing requirements for nutrition counselors in every state. In some states it is legal to do individual nutrition counseling (e.g., New Jersey) and in some states it is illegal (e.g., Maine). The Commission on Dietetic Registration (CDR) also provides information on the licensure and certification requirements for nutrition/dietitian healthcare professionals by state.
Definition 2. A healthcare organization can be defined as any organization meeting the definition of a health care provider as defined in the Code of Federal Regulations (CFR) used by Health and Human Services (HHS). The United States Department of Health and Human Services (HHS) uses the definition of a health care provider stated for individuals and organizations in the Code of Federal Regulations (CFR), specifically 45 CFR 160.103 which states that: "Health care provider means a provider of services (as defined in section 1861(u) of the Act, 42 U.S.C. 1395x(u)), a provider of medical or health services (as defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business." Further detail about section 1861 of the Act, 42 U.S.C. 1395x(u) and (s), can be found at Social Security, Compilation of the Social Security Laws, Part E – Miscellaneous, Definitions of Service. A healthcare organization is any organization meeting the definition of a health care provider as defined in the Code of Federal Regulations (CFR) used by the United States Department of Health and Human Services (HHS).
Definition 3. A healthcare organization can be defined as any organization having a National Provider Identifier (NPI) number assigned by HHS Centers for Medicare and Medicaid Services (CMS). Those who meet the above HHS definition of a health care provider are eligible to obtain a National Provider Identifier (NPI) number from the HHS Centers for Medicare and Medicaid Services (CMS). NPI records can be searched at the National Plan and Provider Enumeration System (NPPES) NPI Registry site. A healthcare organization is any organization having a National Provider Identifier (NPI) number assigned by HHS Centers for Medicare and Medicaid Services (CMS). Note [FUN]: The video for Topic 3 - LBJ 1965 Medicare Bill-Signing Ceremony - is a YouTube video produced by C-SPAN. The video shows part of President Lyndon Baines Johnson's (LBJ's) June 30, 1965 bill-signing ceremony creating Medicare. President Truman was present to receive the first Medicare card.
Definition 4. A healthcare organization can be defined as any organization certified by CMS (Medicare-certified, CMS-certified). CMS also certifies healthcare organizational providers regarding whether such organizations meet the Conditions of Participation (CoP) - the health, safety, and operational standards established in the Code of Federal Regulations (CFR) , specifically 42 CFR.. The organizations on this list are often referred to as Medicare-certified and sometimes CMS-certified. A healthcare organization is any organization certified by CMS (Medicare-certified, CMS-certified).
Definition 5. A healthcare organization can be defined as any organization classified in the North American Industry Classification System (NAICS) in subsector 621, 622, or 623. The North American Industry Classification System (NAICS) “is the standard used by Federal statistical agencies in classifying business establishments for the purpose of collecting, analyzing, and publishing statistical data related to the U.S. business economy.“ It was developed by the United States Office of Management and Budget (OMB). Information about NAICS is found at the Bureau of Labor Statistics (BLS) NAICS Homepage. The 2017 NAICS Manual specifies Sector 62 as Health Care and Social Assistance and describes it as follows: “The Health Care and Social Assistance sector comprises establishments providing health care and social assistance for individuals. The sector includes both health care and social assistance because it is sometimes difficult to distinguish between the boundaries of these two activities. The industries in this sector are arranged on a continuum starting with establishments providing medical care exclusively, continuing with those providing health care and social assistance, and finally finishing with those providing only social assistance. Establishments in this sector deliver services by trained professionals. All industries in the sector share this commonality of process, namely, labor inputs of health practitioners or social workers with the requisite expertise. Many of the industries in the sector are defined based on the educational degree held by the practitioners included in the industry. Excluded from this sector are aerobic classes in Subsector 713, Amusement, Gambling, and Recreation Industries, and non-medical diet and weight reducing centers in Subsector 812, Personal and Laundry Services. Although these can be viewed as health services, these services are not typically delivered by health practitioners.” BLS provides information about this sector in Industries at a Glance (IG), specifically IG - Health Care and Social Assistance: NAICS 62. NAICS divides this sector into subsectors. The first three subsectors list healthcare organizations: Subsector 621 = Ambulatory Health Care Services (approximately 600,000 organizations) Subsector 622 = Hospitals (approximately 13,000 organizations) Subsector 623. Nursing and Residential Care Facilities (approximately 82,000 organization) An expanded list of organizational categories (industries) for these three subsectors is listed in the attached pdf (NAICS_Sector62.pdf) shown below.
NAICS_Sector62.pdf PDF File
See the 2017 NAICS Manual for a more detailed description of each organizational category (industry). A healthcare organization is any organization classified in the North American Industry Classification System (NAICS) in subsector 621, 622, or 623.
Definition 6. A healthcare organization can be defined as any organization classified in NAICS in subsector 621, 622, or 623 or one of the other subsectors with a classification title including the word “health” (e.g., 44611, 532283). There are also other NAICS sectors and subsectors which contain organizations related to health which some may also consider healthcare organizations. They are listed in the attached pdf (NAICS_OtherHealth.pdf) shown below.
NAICS_OtherHealth.pdf PDF File
See the 2017 NAICS Manual for a more detailed description of each organizational category (industry). A healthcare organization is any organization classified in NAICS in subsector 621, 622, or 623 or one of the other subsectors with a classification title including the word “health” (e.g., 44611, 532283) Thus a healthcare organization can be defined using NAICS to be an organization with an organizational code in subsector 621, 622, or 623. Some may choose to expand the definition to also include organizations in one of the other subsectors with a classification title including the word “health” (e.g., 44611, 532283).
