Go to Acronym Guide
ACOAccountable Care Organization, a network of health care providers that band together to provide the full continuum of health care services for patients Benefit PackageSet of services, such as physician visits, hospitalizations or prescription drugs, covered by an insurance policy or health plan Block GrantA lump sum of federal money given to state and local governments for a specific purpose CHIPChildren’s Health Insurance Program, a federal-state program that provides health care coverage to low- and moderate-income children, originally called the State Children’s Health Insurance Program (SCHIP) Chronic DiseasesConditions, such as cancer, heart disease and diabetes, that are the leading causes of death in the U.S. COBRA CoverageConsolidated Omnibus Budget Reconciliation Act of 1986, Pub.L. 99-272, provides certain former employees, retirees, spouses, former spouses and dependent children the right to temporary continuation of health coverage at group rates Co-OpCooperative Health Plan, sold by member-owned and operated non-profit organizations through Exchanges Community RatingA method for setting premium rates for health insurance plans under which all policyholders are charged the same premium for the same coverage Continuum of CareMedical, social, rehabilitative, residential and supportive needs of people who are frail or chronically ill CERComparative Effectiveness Research, compares treatments for the same conditions DSHDisproportionate Share Hospital payments, made by a state’s Medicaid program to hospitals the state designates as serving a disproportionate share of low- income or uninsured patients Dual EligibleTerm used to describe an individual who is eligible for Medicare and for some level of Medicaid benefits Employer Health Care Tax CreditAn incentive mechanism designed to encourage employers, usually small employers, to offer health insurance to employees Employer MandateRequires all employers, or at least all employers meeting size or revenue thresholds, to offer health benefits that meet a defined standard, and pay a set portion of the cost of those benefits on behalf of employees Employer Pay-or-PlayRequires employers to offer and pay for health benefits on behalf of employees, or to pay a specified dollar amount or percentage of payroll into a designated public fund EMRElectronic Medical Record, a medical record in digital format Entitlement ProgramFederal programs, such as Medicare and Medicaid, for which people who meet eligibility criteria have a federal right to benefits Evidence-Based MedicineUse of current best clinical evidence to make decisions about care of individual patients FMAPFederal Medical Assistance Percentage, statutory term for the share of Medicaid costs the federal government bears FPLFederal Poverty Level, working definition of poverty used as the reference point to determine eligibility for certain public programs FFSFee-For-Service, method of paying for medical services under which doctors and hospitals are paid for each service provided FQHCFederally Qualified Health Center, a reimbursement designation referring to several health programs funded under the Health Centers Consolidation Act of 1996, Pub.L. 104-299 Guaranteed Issue/RenewabilityRequires insurers to sell a health insurance policy and renew coverage without regard for health status, use of services or preexisting conditions HCERAHealth Care and Education Reconciliation Act, Pub.L. 111-152, federal statute of corrections to the PPACA |
Health Insurance ExchangePurchasing arrangement through which insurers offer health insurance to select groups HITHealth Information Technology, systems that enable health care entities to gather, store and share information electronically Home Health CareCare delivered at home that includes such services as skilled nursing, social services and occupational therapy Individual MandateA requirement that everyone maintain health insurance coverage LTCLong-Term Care, services needed by people to live independently in the community as well as services provided in institutional settings MAMedicare Advantage, a plan offered by private companies that contract with Medicare to provide optional Medicare benefits, also known as Medicare Part C; typically provides services not covered and paid for under traditional Medicare MedicaidFederal entitlement program that provides health and long-term care coverage to certain categories of low-income Americans Medicaid WaiversAuthority granted by the Secretary of Health and Human Services to allow a state to continue receiving federal Medicaid matching funds even though it is no longer in compliance with certain requirements of the Medicaid statute Medical HomeHealth care setting where patients receive comprehensive primary care services; have an ongoing relationship with a primary care provider who directs and coordinates their care; have enhanced access to non-emergent primary, secondary, and tertiary care; and have access to linguistically and culturally appropriate care MedicareFederal entitlement program that provides health insurance coverage to 45 million people, including people age 65 and older, younger people with permanent disabilities, end-stage renal disease and Lou Gehrig’s disease MLRMedical Loss Ratio, percentage of health insurance premiums spent by an insurance company on health care services, as opposed to administrative costs or profits P4PPay for Performance, health care payment system in which providers receive incentives for meeting or exceeding quality and cost benchmarks; some systems penalize providers who do not meet established benchmarks Payment BundlingMechanism of provider payment where providers or hospitals receive a single payment for the care provided for an episode of illness, rather than per service PCMHPatient-Centered Medical Home, a concept in which a patient’s medical care is coordinated by and funneled through a primary care provider, so that all providers caring for that patient work together to avoid redundancy and miscommunication PPACAPatient Protection and Affordable Care Act, Pub.L. 111-148, legislation signed by President Barack Obama on March 23, 2010, commonly referred to as the health reform law PPSProspective Payment System, mechanism by which health centers are reimbursed by Medicaid and CHIP Preexisting Condition ExclusionPeriod of time when an individual receives no benefits under a health insurance plan for an illness or medical condition for which an individual received medical advice, diagnosis, care or treatment within a specified period of time prior to the date of enrollment in the plan Premium SubsidiesFixed amount of money or a designated percentage of the premium cost provided to help purchase health coverage Safety NetHealth care providers who deliver health care services to patients regardless of their ability to pay SGRSustainable Growth Rate, formula to control Medicare spending by restraining doctors’ fees SNPSpecial Needs Plan, category of Medicare Advantage plans designed to serve institutionalized beneficiaries, dual-eligible beneficiaries and beneficiaries with chronic conditions |
