a b c d e f g h i j k l m n o p q r s t u v w x y z

adult day care - community-based programs providing an array of health, social, and other supportive services to functionally-impaired adults

advance directives - an individual’s right to make decisions about his or her health care. assisted living - as defined in Senate Bill 545, April 1996, a facility that provides housing and supportive services, supervision, personalized assistance, health-related services, or some combination that meets the needs of individuals who are unable to perform or who need assistance in performing the activities of daily living or instrumental activities of daily living in a way that promotes optimum dignity and independence for the individuals.

capitation - health insurance payment mechanism in which the provider automatically receives a fixed payment per enrollee over a specified period to cover a defined set of services, regardless of actual services provided.

care coordination - also known as care management or case management; a collaborative process that promotes quality care and cost effective outcomes which enhance the physical, psychosocial and vocational health of individuals.

Certified Adult Residential Environment Home (CARE home) - a form of assisted living that provides room, board, help in reaching community resources, and protective oversight, but not nursing care or psychiatric treatment to a resident 18 or older who requires these services to remain in the community.

chronic care - the ongoing provision of medical, functional, psychological, social, environmental, and spiritual care services that enable people with serious and persistent health and/or mental conditions to optimize their functional independence and well-being, from the time of condition onset until problem resolution or death. Chronic care conditions are multidimensional, interdependent, complex and ongoing.

cost-sharing - the portion of health expenses that the beneficiary must pay.

cost shifting - the act in which a provider compensates for decreased revenues from one payer by increasing charges to another payer.

custodial care - level of care that provides supervision and assistance.

dementia - deterioration of intellectual faculties resulting from a disorder of the brain and often accompanied by emotional disturbance; disorders include senile dementia of the Alzheimer's type, multi-infarct dementia, reversible dementia, progressive neurological disorders, alcohol-induced dementia, serious and persistent mental illness, spinal cord injury, developmental disability, brain injury. Alzheimer's disease accounts for approximately 60% of cases of organic dementia in the elderly and multi-infarct dementia comprises approximately 25% of the cases of dementia in the elderly.

demonstration waiver - an exemption from certain federal rules that allows policymakers to experiment with Medicare and Medicaid program innovations on a pilot study basis. It is time limited and permits policymakers to expand the knowledge base underlying a program through research and program experimentation. An 1115 Medicaid waiver is a demonstration waiver.

developmental disabilities - for people over age 5, a developmental disability is attributable to physical and mental impairment, or a combination which results in substantial functional limitation in three or more of the following areas of major life activity -- learning, mobility, self-care, receptive and expressive language, self-direction, economic self-sufficiency, and the capacity for independent living. Among infants and children under age 5, it is a substantial developmental delay or specific congenital or acquired condition with a high probability of resulting in developmental disabilities if services are not provided.

health outcome - immediate or delayed consequences of medical intervention that affects an individual physically and/or mentally and relates to the length and quality of life, including death, functional disability, appearance, pain, anxiety and peace of mind.

in-home health services - services provided in the home by a general or specialty home health agency or by a residential services agency that may be provided by personal care attendants, home health aides hired privately and informally or through staff agencies or registries.

inpatient care - services provided to an individual who has been admitted to a hospital or other facility for diagnosis and/or treatment that require at least an overnight stay.

integrated care systems (ICS) - providers or insurance entities that integrate preventive, acute, and long term care services. ICS’s would employ case management and interventions intended to avoid functional deterioration and unnecessary institutionalization.

Intermediate Care Facility for the Mentally Retarded (ICF/MR) - institution designed to provide care and training in activities of daily living and social skills to the person with mental retardation and those with related conditions (e.g., individuals who are developmentally disabled).

Medigap policies - privately purchased insurance policies that provide coverage for medical costs not covered by Medicare.

Older Americans Act (OAA) - originated in 1965 to coordinate and fund a comprehensive service system for older people. It uses age 60 as the main criterion for participation rather than income although it does encourage "targeting" of low-income and minority elders.

payor - legal entity with primary authority for acting on behalf of consumers in distributing resources and ensuring that the primary interests of consumers are honored.

pre-paid health plan - a health plan that provides a specified set of health benefits to a subscriber or group of subscribers in return for a periodic premium.

provider - legal entity with direct service responsibility.

quality of care - the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge; the complex and multidimensional nature of long-term care requires a broader approach to definition and measurement of outcomes.

risk adjustment - increases or reductions in the amount of payment made to a health plan on behalf of a group of enrollees to compensate for health care expenditures that are expected to be lower or higher than average.

risk selection - enrollment choices made by health plans or enrollees on the basis of perceived risk, which result in variation in expected health care expenditures across plans.

Supplemental Security Income (SSI) - a public assistance program which provides financial assistance to persons who are aged, blind, or disabled. Persons determined eligible for SSI are automatically eligible for Medicaid.

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