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UNOFFICIAL 1700.1-48 “Outlier claims” means any claim which has total charges in excess of the outlier threshold, as defined in the State Plan. “Outpatient” means an individual of an organized medical facility, or distinct part of that facility who is expected by the facility to receive and who does receive professional services for less than a twenty-four hour period regardless of the hour of admission, whether or not a bed is used, or whether or not the individual remains in the facility past midnight. “Over-utilization” means to misuse the services of one or more physicians or providers for the same or similar conditions over a period of time. “PACE” means a Program of All-Inclusive Care for the Elderly authorized by the Balanced Budget Act of 1997 that provides a comprehensive service delivery system. PACE is a demonstration project to provide an array of health related services within a capitation payment. “Parent or caretaker relative” means a person who assumes primary responsibility for the care and control of a child under age nineteen years or of an individual who is under age twenty-one years and in receipt of foster care, kinship guardianship or adoption assistance who is residing in the household and is enrolled in Medicaid. “Participating health plan” means a health plan contracted by the State to provide covered services within the service area in which the eligible individual resides that is open to receiving new members. “PCP” or “primary care provider” means a practitioner selected by the beneficiary to manage the beneficiary's utilization of health care services who is licensed in Hawaii and is: (1) A physician, either an M.D. (doctor of medicine) or a D.O. (doctor of osteopathy), and must generally be a family practitioner, general practitioner, general internist, pediatrician or obstetrician-gynecologist