Glossary

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1

1915i search for term

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A

ACA search for term
Accountable Care Organization (ACO) search for term

An Accountable Care Organization (ACO) is comprised of a group of health care service providers, including primary care physicians, specialists, and one or more hospitals, that accept a shared responsibility for both the cost and quality of patient care. Predetermined quality and cost targets promote the overall goal, to restrict growth in volume of clients while encouraging higher care quality. The Affordable Care Act, passed in March 2010, includes a provision that encourages the development of ACOs under Medicare reimbursement. This provision will allow Medicare to share savings accrued by an ACO that provides high quality of care.

ACL search for term
ACO search for term
ADHC search for term
Administration for Community Living (ACL) search for term

The Administration for Community Living (ACL) is an organization within the U.S. Department of Health and Human Services (HHS) with the goal of increasing access to community supports and full participation, while focusing attention and resources on the unique needs of older Americans and people with disabilities. The ACL includes the efforts and achievements of the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities in a single agency, with enhanced policy and program support for both cross-cutting initiatives and efforts focused on the unique needs of individual groups such as children with developmental disabilities, adults with physical disabilities, or seniors, including seniors with Alzheimer's.

Administration on Aging (AoA) search for term

The Administration on Aging (AoA) is located within the U.S. Department of Health and Human Services (HHS) and administers the federal Older Americans Act (OAA), which provides funding for an array of community services for persons 60 and over through mandatory state units on aging that, in turn, allocate the funds to local Area Agencies on Aging.  Please note: As of April 16, 2012, the AoA is a part of the new Administration for Community Living (ACL).

Adult Day Health Care (ADHC) search for term

Adult Day Health Care (ADHC) is a licensed community-based day care program providing a variety of health, therapeutic, and social services to those at risk of being placed in a nursing home.

Adult Day Service Program search for term

Adult Day Services programs are community-based alternatives to the nursing home for those who do not need 24-hour skilled nursing. These programs are designed to keep participants mentally and physically active, reduce isolation, and prevent decline in their abilities.

Adult Foster Homes search for term

Adult Foster Homes are licensed, privately-owned homes that may care for up to 5 individuals who require assistance with Activities of Daily Living. They are the assisted living option closest to direct in-home care, and are staffed 24 hours a day with trained caregivers who provide the necessary assistance.

Agency for Health Care Research and Quality (AHRQ) search for term

The Agency for Health Care Research and Quality (AHRQ) supports health services research to improve the quality of health care and promote evidence-based decision-making. Long-term care is one of the agency’s key areas of research.

Aging and Disability Resource Centers (ADRC) search for term

Aging and Disability Resource Centers (ADRCs) are a collaborative effort of the Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS) and are designed to streamline access to services to help individuals with functional limitations remain in the community. ADRC programs provide information and assistance to individuals needing either public or private resources, to professionals seeking assistance on behalf of their clients and to individuals planning for their future long-term care needs. ADRC programs also serve as the entry point to publicly administered long-term supports including those funded under Medicaid, the Older Americans Act and state revenue programs. ADRCs target services to the elderly and individuals with physical disabilities, serious mental illness, and/or developmental/intellectual disabilities.

AHRQ search for term
Alignment Initiative: search for term

Under the Alignment Initiative, the Centers for Medicare and Medicaid Services (CMS) intends to identify and address conflicting requirements between Medicaid and Medicare that potentially create barriers to high quality, seamless, and cost-effective care for Medicare-Medicaid enrollees (“dual eligibles”). The goal is to create and implement solutions in line with the CMS three part aim, which includes, solutions that advance better care for the individual, better health for populations, and lower costs through improvement.

AoA search for term
ASPE search for term
Assistant Secretary for Planning and Evaluation (ASPE) Office of Disability, Aging, and Long-Term Care search for term

The Assistant Secretary for Planning and Evaluation is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis. ASPE's Office of Disability, Aging, and Long-Term Care Policy develops, analyzes, evaluates, and coordinates HHS policies and programs that support the LTC needs of children, working age adults, and older persons with disabilities.

Assisted Living Facility search for term

Assisted Living Facilities provide aid for elderly persons who need help with Activities of Daily Living (ADLs). Assisted Living is an intermediate form of long-term care, for those who do not require continuous nursing care and wish to remain as independent as possible, but who may simply need help with some daily activities, such as dressing, bathing, eating, or taking medications.

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B

BIPP search for term
Board and Care search for term

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C

California Department of Aging (CDA) search for term

The California Department of Aging (CDA) administers programs that serve older adults, adults with disabilities, and family caregivers. CDA contracts with the network of Area Agencies on Aging, which directly manage a wide array of federal and state-funded services for older adults and their families.

California Department of Developmental Services (DDS) search for term

California’s Department of Developmental Services (DDS) provides services and supports to individuals with developmental disabilities including mental retardation, cerebral palsy, epilepsy, autism and related conditions. Services are provided by state-operated developmental centers and community facilities, and through contracts with 21 nonprofit regional centers.

California Department of Health Care Services (DHCS) search for term

California’s Department of Health Care Services (DHCS) is responsible for administering the Medi-Cal program, which includes institutional LTC, as well as home and community-based services (HCBS) provided through the Medi-Cal “Optional” State Plan services, and Medi-Cal waivers.

California Department of Social Services (DSS) search for term

California’s Department of Social Services (DSS) provides state-level operational and policy oversight for In-Home Supportive Services (IHSS) and Adult Protective Services (APS), two programs that serve the aged, blind and disabled populations. In addition, CDSS’ Community Care Licensing Division provides oversight and enforcement for more than 85,000 licensed residential and adult day care facilities statewide.

California Health and Human Services Agency (CHHS) search for term

The California Health and Human Services Agency (CHHS) oversees thirteen departments and one board that provide a range of health care services, social services, mental health services, alcohol and drug treatment services, income assistance and public health services to Californians from all walks of life. Approximately 33,000 people work for departments in CHHS at state headquarters in Sacramento, regional offices throughout the state and residential facilities serving individuals with mental illness and people with developmental disabilities.

Care Transitions Intervention (CTI) search for term

Intervention designed to streamline care that might have otherwise been fragmented in order to improve care transitions. This intervention aims at improving the care experience for the patient and their family members, while aiming to provide more cost-effective care overall. 

CBAS search for term
CCRC search for term
CDA search for term
CDC search for term
Center for Medicare and Medicaid Innovation (CMMI) search for term

The Center for Medicare and Medicaid Innovation (CMMI) was established by the Patient Protection and Affordable Care Act (ACA) and is responsible for identifying, developing, supporting, and evaluating innovative models of payment and care service delivery for beneficiaries of the Medicare, Medicaid and Child Health Insurance Programs that improve care and health while lowering costs.

Centers for Disease Control and Prevention (CDC) search for term

The Centers for Disease Control and Prevention (CDC) is a major operating component of the U.S. Department of Health and Human Services. The CDC is responsible for creating the expertise, information, and tools that people and communities need to protect their health - through health promotion, prevention of disease, injury, and disability, and preparedness for new health threats.

Centers for Medicare and Medicaid Services (CMS) search for term

The Centers for Medicare and Medicaid Services (CMS) administers the Medicare program and the federal portion of the Medicaid program. In addition, CMS coordinates state licensing and certification of health facilities, including long-term care facilities.

Synonyms: CMS

CFCO search for term
CHHS search for term
CLASS search for term
CMMI search for term
CMS search for term
COHS search for term
Community Development Block Grants search for term

The U.S. Department of Housing and Urban Development provides grants to State and local governments to fund community development in target areas through Community Development Block Grants. Communities are first determined to be either “entitlement” or “non-entitlement” communities, and are then chosen and given resources based on population, poverty levels, overcrowding, age of housing, and relative population growth lag. Grantee activities must either: 1) benefit low- and moderate-income persons, 2) work to prevent or eliminate slums, or 3) address threatening conditions to the community’s health or welfare. Activities include acquiring or developing affordable housing, supplying services to the community’s most vulnerable, and attracting investment to create jobs and expand businesses.

Community First Choice Option (CFCO) search for term

The Community First Choice Option (CFCO) is a Medicaid state plan option that provides community-based attendant services and supports to those meeting nursing facility level of care criteria and includes a six percent FMAP increase over and above a state’s current federal match. In addition, states through this option may also cover the costs of community transition supports (e.g., rent/utility deposits, first month’s rent and utilities, bedding, basic kitchen supplies) for institutionalized individuals who meet eligibility criteria and wish to return to the community.

Community Living Assistance Services and Supports (CLASS) Act search for term

The Community Living Assistance Services and Supports (CLASS) Act is a voluntary, federally administered, consumer-financed long-term care insurance option established by the Patient Protection and Affordable Care Act in 2010. Workers will pay in premiums for at least 5 years in order to receive a daily cash benefit if they develop a disability. Upon determination of eligibility, the cash benefit will be paid based on functional ability, averaging not less than $50 per day, with no aggregate or lifetime limit. The benefit could be used for a range of community support services, from respite care to home care.

Community-Based Adult Services (CBAS) search for term

The Community-Based Adult Services (CBAS) program operates in California as an outpatient, facility-based service program that delivers skilled nursing care, social services, therapies, personal care, family and caregiver training and support, meals, and transportation to older persons and adults with chronic conditions and/or disabilities that are at risk of needing institutional care. This program is transitioning to a Medi-Cal managed care benefit, and replaces the Adult Day Health Care program (ADHC), which was a Medi-Cal State Plan optional benefit. The Centers for Medicare and Medicaid Services (CMS) approved the state’s request to amend the 1115 “Bridge to Reform” waiver and implement the CBAS program as part of this waiver.

Community-Based Care Transitions Program search for term

Community-Based Care Transitions Program (as defined in the Patient Protection and Affordable Care Act Section 3026): a program aimed at reducing hospital readmission rates by utilizing community-based organizations that provide services across the continuum of care through arrangements with hospitals in the Community-Based Care Transitions Program. This program is for high-risk Medicare beneficiaries, as defined as having: multiple chronic conditions, cognitive impairment, history of multiple readmissions, or any other chronic disease or risk factor as determined by the Secretary of Health and Human Services. The program started January 1, 2011 and will be conducted over a five-year period.

Continuing Care Retirement Community (CCRC) search for term

Continuing Care Retirement Communities (CCRCs) are residential communities with a combination of housing options for seniors designed to flexibly meet health and housing needs over an extended period of time. As such, CCRCs provide independent living options, assisted living, and nursing home facilities, so that as needs change, a senior can be smoothly accommodated. These residential communities allow seniors to become familiar with a single setting, as opposed to relocating whenever a different style or intensity of care is needed. Unlike assisted living, seniors sign a lifelong commitment contract to a CCRC in advance.

County-Organized Health System (COHS) search for term

The County-Organized Health System (COHS) is a type of Medi-Cal managed care that currently serves about 885,000 beneficiaries through six health plans in 14 counties. In the COHS counties, California’s Department of Health Care Services (DHCS) contracts with a health plan created by the County Board of Supervisors. The County administers the health plan, and all Medi-Cal beneficiaries residing in that county are enrolled in the COHS health plan.

CTI search for term
Culture Change Movement search for term

The Culture Change Movement is a grassroots movement that focuses on a paradigm shift to a supportive home environment within nursing homes, in lieu of the traditional, structured-schedule medical facility mindset. The people are put first; residents are able to dictate their own days and their own care, instead of following a forced routine. Nursing homes joining this movement often apply the “Neighborhood Model,” which involves breaking down a nursing home into smaller “households” of 12 to 20 seniors, who share common spaces and make all of their own life choices. Caregivers are assigned to each household to provide assistance and care and to forge relationships with the seniors. Advocates of the movement believe that Culture Change better respects the rights and dignity of the residents, improves their mental health, and increases their enjoyment and life-expectancy.

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D

DDDM search for term

Dignity Driven Decision Making (DDDM)

Synonyms: Dignity Driven Decision Making

DDS search for term
DHCS search for term
Dignity Driven Decision Making (DDDM) search for term

The concept of dignity-driven decision making builds on previous efforts to define and develop patient- and family-centered care for people with advanced illness. More a framework than a rigid structure, the dignity-driven decision making emphasizes the centrality of a collaborative process in which patients (most of whom are elderly), their families, and clinicians work together continuously to define the goals of care and how best to implement them.

Synonyms: DDDM

Direct Care Workforce search for term

The Direct Care Workforce is comprised of personal care attendants, home health aides, and nursing aides who provide services and supports to individuals with disabilities and functional needs, including seniors and those with physical or intellectual disabilities.

DSS search for term
Dual Eligibles search for term

Dual eligibles are those who are eligible for both Medicare and Medicaid. These individuals are also known as "dually eligible."

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E

Elder Economic Security Standard Index search for term

The Elder Economic Security Standard Index (Elder Index) is a measure of income adequacy for older adults developed by Wider Opportunities for Women in collaboration with the Gerontology Institute at the University of Massachusetts Boston. The Elder Index benchmarks basic costs of living for elder households. It illustrates how costs of living vary geographically and are based on the characteristics of elder households: household size, homeownership or renter, mode of transportation, and health status. The costs are for basic needs of elder households; they are based on market costs and do not assume any subsidies.

Elder Index search for term

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F

Faith in Action - Elder Outreach search for term

Elder Outreach, headed by the larger Faith In Action organization, is a program with locations throughout the country dedicated to providing non-medical assistance to aged (65 and over) individuals, in order to allow them to remain as independent as possible. Potential beneficiaries apply to receive the services, and the program does not discriminate on the basis of income. Elder Outreach is dependent on volunteers, who assist the senior with activities such as grocery shopping, transportation, and light housekeeping, but who also provide companionship through regular visits.

FDA search for term
Federal Medical Assistance Percentage (FMAP) search for term

The Federal Medical Assistance Percentage (FMAP) is used in determining the amount of Federal matching funds for State Medicaid expenditures for assistance payments for certain social services, and State medical and medical insurance expenditures. The Social Security Act requires the Secretary of Health and Human Services to calculate and publish the FMAPs each year. Section 1905(b) of the Social Security Act specifies the formula for calculating FMAP.

Federal Poverty Guidelines search for term

The Federal Poverty Guidelines are the simplified version of the federal poverty measure. The values represent the aggregate annual income at which one is considered “impoverished” by the government, dependent upon the number of persons per household. The guidelines are updated annually by the Department of Health and Human Services to account for changes in cost of living, and are commonly used to determine eligibility for various federal programs, such as Medicaid.

Financial Alignment Initiative search for term

Under the Financial Alignment Initiative, the Centers for Medicare and Medicaid Services (CMS) will test two models for States to better align the financing of the Medicare and Medicaid programs and integrate primary, acute, behavioral health and long term services and supports for their Medicare-Medicaid enrollees. These two models include: 1) a capitated model in which a State, CMS, and a health plan enter into a three-way contract, and the plan receives a prospective blended payment to provide comprehensive, coordinated care; and 2) a managed fee-for-service model in which a State and CMS enter into an agreement by which the State would be eligible to benefit from savings resulting from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid.

FMAP search for term
Food and Drug Administration (FDA) search for term

The Food and Drug Administration (FDA) is responsible for assuring the safety, efficacy, and security of a number of products including medications, vaccines and medical devices.

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G

Geographic Managed Care (GMC) Model search for term

The Geographic Managed Care (GMC) model is a type of Medi-Cal managed care that serves approximately 450,000 beneficiaries in two counties: Sacramento and San Diego. In these GMC counties, the state contracts with several commercial plans.

GMC search for term

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H

Health Home search for term
Health Maintenance Organization (HMO) search for term

A Health Maintenance Organization (HMO) is a kind of managed care organization that provides health care coverage by physicians, hospitals, and other providers with which the HMO has a contract. Individuals enrolled in an HMO may only use providers that are contractually related to the HMO; using providers outside the HMO network will come with added costs. In a "Staff Model" HMO, physicians are salaried and work in the HMO facilities. In a "Group Model" HMO, the HMO contracts with physicians rather than employ them directly. In a "Network Model" HMO, an HMO may contract with any combination of physician groups, Independent Practice Associations, or individual physicians.

Health Resources and Services Administration (HRSA) search for term

The Health Resources and Services Administration (HRSA) is the primary federal agency located within the U.S. Department of Health and Human Services for improving access to health care services for people who are uninsured, isolated or medically vulnerable, strengthening the health workforce, building healthy communities, and improving health equity.

HHS search for term
HMO search for term
HRSA search for term
HUD search for term

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I

IHS search for term
ILC search for term
Independent Living Center (ILC) search for term

Independent Living Centers (ILCs) are consumer-controlled, community based, cross disability, nonresidential private nonprofit agencies designed and operated within local communities by individuals with disabilities. ILCs provide independent living services that seek to maximize a person's ability to live independently in the environment of their own choosing. They are outlets for disability assistance and information. Services include: advocacy, counseling, housing and personal assistant referrals, emergency assistance, transportation, job placement and coaching, and training in various independent living skills.

Indian Health Service (IHS) search for term

The Indian Health Service (HIS) is responsible for providing federal health services to American Indians and Alaska Natives. In collaboration with CMS and other organizations, the IHS works to foster more culturally appropriate, non-institutional services for American Indian and Alaska Native beneficiaries of Medicare, Medicaid, and Children’s Health Insurance Program.

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L

Long-Term Care Insurance (LTCi) search for term

Long-term care insurance is a type of insurance developed specifically to cover the costs of long-term care services, most of which are not covered by traditional health insurance or Medicare. These include services in the home, such as assistance with Activities of Daily Living as well as care in a variety of facility and community settings. The cost of a long-term care insurance policy is based on the type and amount of services chosen to have covered, an individual’s age when the policy is purchased, and any optional benefits selected, such as Inflation Protection. Long-term care insurance policies have a benefit period or lifetime benefit maximum, which is the total amount of time or total amount of dollars up to which benefits will be paid. Common benefit periods for long-term care policies are two, three, four, and five years, and lifetime or unlimited coverage.

Long-Term Care Ombudsman Program search for term

The Long-Term Care Ombudsman Program is an OAA, Title VII program that investigates and endeavors to resolve complaints made by, or on behalf of, residents in long-term care facilities including nursing homes, residential care facilities for the elderly, and assisted living facilities. The goal of the Long-Term Care Ombudsman Program is to advocate for the rights of all residents of long-term care facilities.

LTCi search for term

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M

Managed Care search for term

Method of organizing and financing health care services which emphasizes cost-effectiveness and coordination of care. Managed care organizations (including HMOs, PPOs and PSOs) receive a fixed amount of money per client/member per month (called a capitation or bundled payment), no matter how much care a member needs during that month.

 

Medi-Cal search for term

Medi-Cal is California's Medicaid program.

Medicaid search for term

Medicaid is the medical assistance program jointly funded by states and federal government to cover health services for low-income individuals, including seniors, persons with disabilities, families with children, pregnant women, and selected others.

Medicaid Home and Community-Based Services State Plan Option (1915i) search for term

The Medicaid Home and Community-Based Services State Plan Option , or 1915 (i), permits states to both extend HCBS enrollment to individuals with incomes up to 300 percent of Supplemental Security Income (SSI) and offer the full range of Medicaid benefits to all eligible individuals receiving services through the 1915(i) option.

Medicaid Waiver search for term

The Centers for Medicare and Medicaid Services (CMS) can grant waivers to state Medicaid programs that allow states to limit the availability of services geographically, target specific populations or conditions, control the number of individuals served and cap overall expenditures which are not allowed under the Medicaid statute. CMS may waive the following requirements: (1) Statewideness—allows states to target waivers to particular areas of the state where the need is greatest, or perhaps where certain types of providers are available; (2) Comparability of services—allows states to make waiver services available to persons at risk of institutionalization, without being required to make waiver services available to the Medicaid population at large. States use this authority to target services to particular groups, such as elderly individuals, technology-dependent children or persons with mental retardation or developmental disabilities. States may also target services on the basis of disease or condition, such as Acquired Immune Deficiency Syndrome (AIDS); and/or (3) Income and resource rules applicable in the community—allows states to provide Medicaid to persons who would otherwise be eligible only in an institutional setting, often due to the income and resources of a spouse or parent.

Medical Home search for term

The medical home is an approach to providing comprehensive primary care in a patient-centered way. The medical home has a primary care focus, where the primary care provider acts as a liaison to other providers and helps to manage a patient's overall care. Care is provided with a "whole person orientation" and is coordinated and/or integrated across providers and settings.

Medicare search for term

The federal health insurance program for individuals age 65 and older, younger individuals with disabilities, and those with End State Renal Disease. Fee-for-service, or traditional Medicare, is composed of Medicare Part A (Hospital Insurance) and Medicare Part B (Supplementary Medical Insurance).

Medicare Part A search for term

Medicare Part A is hospital insurance that covers inpatient care, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people do not pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

Medicare Part B search for term

Medicare Part B is supplementary medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, some home health services, and other medical services not covered by Part A. Payments for Part B coverage are directly withdrawn from individuals' Social Security checks each month.

Medicare Part C - Medicare Advantage search for term

Medicare Advantage Plans or "MA Plans" are health plans, such as HMOs or PPOs, offered by private companies approved by Medicare. Individuals eligible for Medicare Part A and B can enroll in an MA Plan. Often MA Plans offer additional coverage not provided under traditional Medicare.

Medicare Part D search for term

Medicare prescription drug coverage (Part D) is available to everyone with Medicare. To get Medicare drug coverage, beneficiaries must join a Medicare drug plan. Plans vary in cost and drugs covered. Those who are enrolled in a Medicare Advantage Plan may have prescription covered under Part D rolled into their plan.

Medicare Part D Low-Income Subsidy search for term

The Medicare Part D Low-Income Subsidy (LIS) provides financial assistance for Medicare beneficiaries who are dually eligible for Medicaid, are enrolled in a Medicare Savings Program (MSP), or are receiving Supplemental Security Income (SSI). Most LIS recipients do not need to enroll as they are automatically enrolled when they become eligible for Medicaid, an MSP, or SSI. Those who are eligible for this low-income subsidy get help paying for their monthly premium, yearly deductible, prescription co-insurance and co-payments and have no gap in coverage.

Medicare Savings Program search for term

Medicare Savings Programs (MSP) are programs available to low-income Medicare beneficiaries who may not meet the income and asset limits to be eligible for full Medicaid benefits but who do qualify for some financial assistance with Medicare cost sharing, including co-pays, deductibles, and co-insurance. There are four MSPs: the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Beneficiary (SLMB) program, the Qualified Individual (QI) program, and the Qualified Disabled Working Individual (QDWI) program.

Medicare-Medicaid Coordination Office (MMCO) search for term

The Medicare-Medicaid Coordination Office (MMCO; also known as the Federal Coordinated Health Care Office) serves people who are enrolled in both Medicare and Medicaid (“Medicare-Medicaid enrollees” or “dual eligibles”). The MMCO works with the Medicaid and Medicare programs, across Federal agencies, States and stakeholders to align and coordinate benefits between the two programs effectively and efficiently. We partner with States to develop new care models and improve the way Medicare-Medicaid enrollees receive health care.

Medigap search for term

A Medigap policy is an insurance product sold by private insurance companies to fill the “gaps” in traditional Medicare coverage. Medigap policies help pay some of the health care costs that traditional Medicare does not cover. In order to purchase a Medigap policy, one must be eligible for and enrolled in Medicare Part A and Part B. The Centers for Medicare and Medicaid Services (CMS) has created 12 standardized plans, labeled A through L, each offering a different package of benefits.

MFP search for term
MMCO search for term
Money Follows the Person (MFP) search for term

The Money Follows the Person (MFP) program helps to facilitate the relocation of eligible individuals receiving care in institutions for a certain length of time back to the community. This demonstration provides a 75 percent FMAP for home- and community-based services provided to individuals in the first year following relocation from an institution.

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N

Naturally Occurring Retirement Community (NORC) search for term

"Naturally Occurring Retirement Community" is a term used to describe neighborhoods with a predominantly elder demographic. These communities were not built or designed to focus on the elderly, but instead were merely the result of individuals aging in place, or of migrations of other older people to the area. NORC Supportive Service Programs supply a variety of services to these neighborhoods, the idea being to bring the services to where the seniors live. Services programs and projects work to enhance the overall quality of life in the community. They include the provision of cost-effective healthcare and support with increased availability, cooperative health promotion, community improvement and volunteering opportunities, and crisis prevention.

NORC search for term

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O

Older Americans Act (OAA) search for term

The Older Americans Act (OAA) , first enacted in 1965, provides long-term services and supports to Americans age 60 and over to help them to remain independent in their own homes, and to protect and support them in the workplace. Programs are not limited by income; services are available to all adults age 60 and over. The act established the federal Administration on Aging (AoA) as well as the state agencies on aging.

Olmstead Decision search for term

In 1999, the U.S. Supreme Court ruled in the case of Olmstead v. L.C., finding that the unjustified institutional isolation of people with disabilities is a violation of the Americans with Disabilities Act of 1990 (ADA).

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P

PACE search for term
Patient Centered Medical Home search for term
Patient Protection and Affordable Care Act search for term

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (P.L. 111-148), which, along with the Health Care and Education Reconciliation Act of 2010, make up health care reform. The laws focus on the reform of the private health insurance market but also implement efforts to control the growth of Medicare costs. The Act also makes significant strides toward improving the continuum of care by: (1) supporting the rebalancing of long-term services and supports from institutional to home and community-based settings; (2) improving the coordination of health and supportive services; (3) improving access to medications and reducing the cost burden on seniors; (4) reinforcing the existing workforce and establishing incentives to grow the workforce; and (5) strengthening quality and consumer protections for seniors.

Patient-Centered Care search for term

Services that put the patient and their families at the center of care while collaborating with health care and social services professionals to make care-related decisions. This type of care aims to integrate the patient’s cultural traditions, personal preferences, family situations, and lifestyles while making an effort to provide services that are seamless from the users’ perspectives. 

PFFS search for term
PPO search for term
Preferred Provider Organization (PPO) search for term

A Preferred Provider Organization (PPO) is a health care organization that contracts with physicians, hospitals, and other providers to provide services to an enrolled population. A PPO is similar to an HMO, but care is paid for as it is received rather than in advance in the form of a scheduled fee (i.e., a per-member, per-month payment). Enrollees may see providers outside of their PPO network but at a greater expense to the enrollee.

Private Fee-For-Service Plan (PFFS) search for term

A Private Fee-for-Service Plan (PFFS) is a Medicare Advantage health plan, offered by a licensed organization, which contracts with the Centers for Medicare and Medicaid Services to provide beneficiaries with all their Medicare benefits plus any additional benefits the health plan chooses to provide. The biggest difference between a PFFS and other Medicare Advantage plans (e.g., HMOs, PPOs, etc.) is that the beneficiary is not required to use a network of providers. The health plan is still at risk for all services provided but reimburses providers per service provided.

Program of All-Inclusive Care for the Elderly (PACE) search for term

The Program for All-Inclusive Care for the Elderly (PACE) is a long-term coordinated care delivery program which first appeared in San Francisco’s On Lok program and has since been replicated across the nation. It serves individuals age 55 and over, and who are certified to need nursing home care. The main goal of PACE is to avoid unnecessary and costly trips to the hospital or expenditures on nursing home care. The model emphasizes autonomy and community-based care over institutional care by providing an integrated continuum of both primary and specialty long-term care services. The coordination of a full range of services by a single institution allows for the efficient and cost-effective care of seniors with multiple health problems. PACE services are paid for by an individual’s Medicare and/or Medicaid, or can be purchased privately (e.g. by those ineligible for Medicaid).

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Q

QDWI search for term
QI search for term
QMB search for term
Qualified Disabled Working Individual (QDWI) search for term

The Qualified Disabled Working Individual (QDWI) program is a Medicare Savings Program for working individuals under age 65 who lost their premium-free Medicare Part A when they returned to work. Eligible individuals may buy Medicare Part A and have the premium covered by Medicaid. To be eligible, individuals must have income at or below 200% of the Federal Poverty Level and have limited assets.

Qualified Individual (QI) search for term

The Qualified Individual (QI) program is a Medicare Savings Program for Medicare beneficiaries who have higher incomes than those who qualify for the Specified Low-Income Medicare Beneficiaries (SLMB) program. To be eligible, individuals must have income between 120% and 135% of the Federal Poverty Level and have limited assets.

Qualified Medicare Beneficiary (QMB) search for term

The Qualified Medicare Beneficiary (QMB) program is a Medicare Savings Program targeted to low-income Medicare beneficiaries who do not meet the income and asset limits to be eligible for full Medicaid benefits. Individuals must have incomes at or below 100% of the Federal Poverty Level and have limited assets. For individuals who meet the eligibility criteria for the QMB program, the Medicaid program will cover Part A premiums and deductibles, Part B premiums and deductibles, and Part A and B co-insurance. These individuals also qualify for the Medicare Part D Low Income Subsidy, which provides assistance with the premium, deductible, and co-payments for a Part D prescription drug plan.

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Residential Care Facilities for the Elderly (RCFE) search for term

Residential Care Facilities for the Elderly (RCFEs) are licensed facilities that provide individuals with functional and/or cognitive impairments, mostly elderly, with supportive housing and limited supportive services such as support with Activities of Daily Living (ADLs), transportation, shopping, meals, cleaning, and laundry services.

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SAMHSA search for term
Section 202 - Supportive Housing for the Elderly search for term

Through the Section 202 Program, the U.S. Department of Housing and Urban Development supplies interest-free capital advances to private nonprofits to finance the purchase or development of affordable supportive housing for very low-income or frail older persons, as well as rental assistance subsidies to help ensure affordability. The housing allows seniors to live independently while providing needed services such as cooking, cleaning, and transportation. As long as the project serves very low-income seniors for 40 years or more, the capital advances received by the nonprofit sponsor need not be repaid.

Section 8 - Housing Vouchers search for term

The Section 8 Housing Choice Voucher Program, a U.S. Department of Housing and Urban Development (HUD) program, provides vouchers as rent subsidies for low-income seniors or disabled persons as well as other low income individuals. HUD funds are given to local public housing agencies, which in turn administer them in the form of vouchers. The public housing agencies determine eligibility based on total annual gross income and family size. Voucher recipients are free to choose their own housing, provided it meets program requirements and standards.

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Social Security Administration (SSA) search for term

The Social Security Administration (SSA) is an independent federal agency that administers Social Security, a social insurance program consisting of retirement, disability, and survivor's benefits. To qualify for these benefits, most American workers pay Social Security taxes on their earnings for at least 40 quarters. The three social insurance programs are: (1) Retirement Insurance Program; (2) Survivors Insurance Program; and (3) Social Security Disability Insurance (SSDI) Program.

Social Security Disability Insurance (SSDI) search for term

Social Security Disability Insurance (SSDI) is a Federal program that provides monthly payments to those who are unable to work for a year or more due to a disability. The payments generally continue until the recipient is able to work again. “Work incentives,” such as Medicare coverage and continued monthly benefits, can be provided to assist in the transition back to work by supporting a beneficiary while he or she assesses his or her ability to return to full-time work. To qualify, one must have paid payroll taxes to Social Security and have a medical condition that meets the Social Security definition of disability. “Disability” is defined in a strict sense, with the following conditions (all must be met): (1) one cannot do work that was previously possible; (2) one is deemed unable to adjust to other work due to the medical condition(s); and (3) the disability has lasted or is expected to last for one year or more, or to result in death.

Special Needs Plan (SNP) search for term

A Special Needs Plan (SNP) is a special category of Medicare Advantage Plans designed for Medicare beneficiaries with special needs characteristics. These special needs include: institutionalized beneficiaries, dually-eligible beneficiaries, and beneficiaries with certain chronic conditions (e.g., cardiovascular disease, diabetes, congestive heart failure, osteoarthritis, etc.).

Specified Low-Income Beneficiary (SLMB) search for term

The Specified Low-Income Beneficiary (SLMB) program is a Medicare Savings Program for Medicare beneficiaries who have higher incomes than those who qualify for the Qualified Medicare Beneficiary (QMB) program. To be eligible, individuals must have income between 100% and 120% of the Federal Poverty Level and have limited assets.

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State Balancing Incentives Payments Program (BIPP) search for term

The State Balancing Incentives Payment Program (BIPP) provides qualifying states with either a 2 or a 5 percentage point increase in their federal match for Medicaid Home- and Community-Based Services (HCBS) costs. Participating states must make certain program changes designed to increase use of HCBS in Medicaid, including: 1) a No Wrong Door–Single Entry Point system; 2) conflict-free case management services; and 3) a core standardized assessment instrument. This program runs from October 1, 2011 through September 30, 2015.

Substance Abuse and Mental Health Services Administration (SAMHSA) search for term

The Substance Abuse and Mental Health Services Administration (SAMHSA) supports States, Territories, Tribes, communities, and local organizations through grant and contract awards and provides national leadership in promoting the provision of quality behavioral health and substance use treatment services.

Supplemental Security Income (SSI) search for term

Supplemental Security Income (SSI) is a federal income supplement administered by the Social Security Administration and funded by general tax revenues, rather than Social Security payroll taxes. SSI is designed as an income supplement program for aged (65 and over), blind, or disabled persons who meet citizenship or residency requirements.

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Two-Plan Model search for term

The Two-Plan model is a type of Medi-Cal managed care that serves about three million beneficiaries in 14 counties. In most Two-Plan model counties, there is a “Local Initiative” (LI) and a “commercial plan” (CP). DHCS contracts with both plans. Local stakeholders are able to give input when the LI is created, and it is designed to meet the needs and concerns of the community. The CP is a private insurance plan that also provides care for Medi-Cal beneficiaries.

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U.S. Department of Health and Human Services (HHS) search for term

The U.S. Department of Health and Human Services (HHS) is the primary federal agency responsible for health and human services, including long-term care services. Within HHS are the Centers for Medicare and Medicaid Services and the Administration on Aging, the two primary agencies that have direct responsibilities related to long-term care.

U.S. Department of Housing and Urban Development (HUD) search for term

The U.S. Department of Housing and Urban Development is the federal agency responsible for creating strong, sustainable, and inclusive communities and quality affordable homes for all. To accomplish some of these goals, HUD has pioneered various community development programs, including Section 8 - Housing Vouchers, Section 202 - Supportive Housing for the Elderly, Community Development Block Grants, and the HOME Investment Partnerships Program.

Uniform Assessment search for term

Uniform assessment can be defined as a common assessment tool or process to assess an individual’s functional capacity and needs that is used across programs and services to guide care planning and resource utilization.

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Villages search for term

The Village concept first appeared with the “Beacon Hill Village” in Boston, MA in 2001. The “Village” model has been spreading to and growing in locations across the country. There are currently over 48 Village organizations nationwide. The model consists of neighborhoods of seniors with a common desire to remain independent and in their own homes. They are membership-driven organizations (members pay small dues), in which small staffs and volunteers coordinate services such as in-home assistance or transportation. Informal community-building is a large factor in this model, and Villages are a source of mutual support, activity, and friendship.

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