The following words and phrases when used in this article shall have the meanings given to them in this section unless the context clearly indicates otherwise:

“All Patient Refined Diagnosis Related Groups.” A version of Diagnosis Related Groups that further subdivide the Diagnosis Related Groups into four severity-of-illness and four risk-of-mortality subclasses within each Diagnosis Related Groups.

“Diagnosis Related Groups.” A classification system that uses patient discharge information to classify patients into clinically meaningful groups.

“Hospital.” A public or private institution licensed as a hospital under the laws of this Commonwealth that participates in the Medicaid program.

“Managed care organization.” A licensed managed care organization with whom the department has contracted to provide or arrange for services to a Medicaid recipient.

“Medicaid program.” The Commonwealth's medical assistance program authorized under Article IV.

“Potentially avoidable admission.” An admission of an individual to a hospital or long-term care facility that may have reasonably been prevented with adequate access to ambulatory care or health care coordination.

“Potentially avoidable complication.” A harmful event or negative outcome with respect to an individual, including an infection or surgical complication, that:

“Potentially avoidable emergency visit.” Treatment of an individual in a hospital emergency room or freestanding emergency medical care facility for a condition that may not require emergency medical attention because the condition could be or could have been treated or prevented by a physician or other health care provider in a nonemergency setting.

“Potentially avoidable event.” Any of the following:

“Potentially avoidable readmission.” A return hospitalization of an individual within a period specified by the department that may have resulted from a deficiency in the care or treatment provided to the individual during a previous hospital stay or from a deficiency in posthospital discharge follow-up. The term does not include a hospital readmission necessitated by the occurrence of unrelated events after the discharge. The term includes the readmission of an individual to a hospital for: