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Glossary |
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| Word/Acronym |
Definition |
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ACOG
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American College of Obstetricians and Gynecologists.
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Acute Care Services
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Care that is generally provided for a short period of time to treat a certain illness or condition
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ADAPs
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AIDS Drug Assistance Programs (ADAPs), authorized under Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, provide HIV-related prescription drugs to underinsured and uninsured individuals living with HIV/AIDS. Each state or territory administers its own ADAP.
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Age adjustment
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A technique for "removing" the effects of age from crude rates so as to allow meaningful comparisons across populations with different underlying age structures. Age-adjusted rates are calculated by applying the age-specific rates of various populations to a single standard population.
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AHRQ
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The Agency for Healthcare Research and Quality, formerly the Agency for Health Care Policy and Research, is a Public Health Service agency within the U.S. Department of Health and Human Services which supports, conducts, and disseminates research on health care outcomes, quality, cost, use, and access.
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Aid to Families with Dependent Children
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AFDC provided cash assistance and work support, including child care assistance, to low income families with children until the program was repealed in 1996 and replaced with TANF (Temporary Assistance to Needy Families, described below).
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Anonymous HIV Testing
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HIV testing under which names are not associated with the test results.
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BRFSS
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The Behavioral Risk Factor Surveillance System (BRFSS), the world's largest telephone survey, uses a state-based system to track the prevalence of health risk behaviors among American adults.
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Bureau of Labor Statistics (BLS)
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The federal government's principal fact-finding agency of labor economics that provides statistics reflecting the social and economic conditions of U.S. workers, workplaces, and workers' families.
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Center for Mental Health Services (CMHS)
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CMHS awards grants to CBOs as part of the Minority HIV/AIDS Initiative for the treatment of mental health disorders related to HIV disease. The Targeted Capacity Expansion grants are designed to expand and strengthen the capacity of community-based organizations to provide culturally appropriate mental health treatment services to racial and ethnic minorities.
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Center for Substance Abuse Prevention (CSAP)
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CSAP funds grants under the Targeted Capacity Expansion Initiatives for Substance Abuse Prevention and HIV Prevention in Minority Communities, which generally go to CBOs and Universities. The money is targeted to improve the effectiveness of substance abuse prevention and HIV prevention services. The programs are targeted at youth and other at-risk groups in minority communities.
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Center for Substance Abuse Treatment (CSAT)
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CSAT awards grants to CBOs through its Targeted Capacity Expansion-HIV/AIDS Services programs. The program addresses gaps in substance abuse treatment capacity, as well as increases the availability and accessibility of substance abuse treatment and HIV/AIDS services for ethnic and racial minority populations and substance abusers. The program in funded through the MHAI.
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Centers for Disease Control and Prevention (CDC)
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A government agency designated to provide direction in the prevention and control of communicable and other diseases, respond to public health emergencies, and coordinate programs such as the Behavioral Risk Factor Surveillance System (BRFSS) and the National Center for Health Statistics (NCHS).
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Centers for Medicare & Medicaid Services (CMS)
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CMS administers Medicare, Medicaid and the State Children's Health Insurance Program (SCHIP) which provide health care to America's aged disabled, and low-income populations. Formerly called HCFA, the Health Care Financing Administration.
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Clinical Trials, Phases I, II, III and IV
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Phase I: Research is conducted on a small group of volunteers (20 to 80 people) for the first time to evaluate its safety, determine a safe dosage range and identify side effects.
Phase II: The experimental drug or treatment is given to or a procedure is performed on a larger group of people (100 to 300 individuals) to further measure its effectiveness and safety.
Phase III: Further research is conducted to confirm the effectiveness of the drug, treatment or procedure, monitor the side effects, compare commonly used treatments and collect information on safe use. Phase III trials are typically conducted on 1,000 to 3,000 individuals.
Phase IV: After the drug, treatment or medical procedure is marketed, investigators continue testing to determine the effects on various populations and whether there are side effects associated with long-term use.
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COBRA
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COBRA, the Consolidated Omnibus Budget Reconciliation Act, amended the Employee Retirement Income Security Act of 1974 to require temporary group continuation health insurance for employees and their dependents following death of a spouse, loss of a job, reduction in hours worked, or divorce. The federal law applies only to employees in firms with 20 or more workers; state laws may cover smaller firms.
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Code-Based Reporting
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An HIV surveillance technique whereby HIV reports are submitted to public health departments using a coded patient identifier comprised of different, partial personal identifiers (e.g., date of birth, initials of patient name, portions of patient's security number, etc.) without the patient name.
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Confidential HIV Testing
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HIV testing under which a person's name is recorded along with the test results. Confidential results are made available to medical personnel and, in most states, the state health department.
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Current Population Survey (CPS)
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The CPS is a national monthly household survey conducted by the Bureau of the Census to gather various information including health insurance status on the noninstitutionalized U.S. population.
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Deductible
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The amount of loss or expense that must be incurred by an insured or otherwise covered individual before an insurer will assume any liability for all or part of the remaining cost of covered services. Deductibles may be either fixed-dollar amounts or the value of specified services (such as two days of hospital care or one physician visit). Deductibles are usually tied to some reference period over which they must be incurred, e.g., $100 per calendar year, benefit period, or spell of illness.
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Department of Health & Human Services (HHS)
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HHS administers many of the social programs at the Federal level dealing with the health and welfare of the citizens of the United States. Agencies under HHS include Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS).
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Disproportionate Share Hospital payments (DSH)
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DSH payments are special payments Medicare or Medicaid makes to hospitals that treat a disproportionately high number of low-income patients.
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Drug Formulary
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A list of preferred pharmaceutical products that health plans, working with pharmacists and physicians, have developed to encourage greater safety, effectiveness and efficiency in dispensing prescription drugs. These drugs are generally covered at the highest benefit level. In some Medicare health plans, doctors must order or use only drugs listed on the health plan's formulary.
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Dual Eligibles
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Individuals who receive Medicare (Part A and Part B) and also some form of Medicaid assistance. This group includes 1) "Full Medicaid," those receiving full Medicaid benefits (i.e., prescription drugs and nursing home care) and Medicaid coverage of Medicare's financial requirements, and 2) "Buy-Ins," those receiving some level of assistance with Medicare cost-sharing and premiums only.
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ERISA
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ERISA, the Employee Retirement Income Security Act, is a federal law passed in 1974 that sets federal reporting and disclosure rules for employer-sponsored health plans. Under ERISA, companies that self-insure and pay for workers' health benefits directly are exempt from state insurance regulation and taxes.
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External Review
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States with an external review process provide the opportunity for consumers and their providers to challenge a health plan's denial of medical coverage. An independent review agent examines the case and has the authority to determine as to whether the medical claim should be covered.
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Federal Fiscal Year (FFY)
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Federal Fiscal Year refers to the one year period of time from October 1st of one year to September 30th of the following year.
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Federal Poverty Level (FPL)
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The Federal Poverty Level was established to help government agencies determine eligibility levels for public assistance programs such as Medicaid. FPL is represented in this resource as poverty thresholds as opposed to the slightly different poverty guidelines. The FPL for a family of three in 2004 was $15,670 for 48 contiguous states and District of Columbia.
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Full-Year Equivalent Dual Eligible
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The full-year equivalent dual eligible enrollment is calculated by adding the total months of enrollment for all full dual eligibles in each state and dividing the total by 12 months. For example, to determine the full-year equivalent for one dual enrolled for six months and one dual enrolled for 12 months, compute (6+12)/12 to get 1.5 full-year equivalents. These figures are based on the October 14, 2005 letters to Medicaid Directors referenced above. The "full-year equivalent" dual eligible enrollment differs from the "full" dual eligible enrollment described in Dual Eligibles Enrollment, 2003, a separate topic on statehealthfacts.org. The full dual eligible enrollment is calculated by adding all full duals that were "ever on" the rolls during calendar year 2003 based on the MSIS.
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Guaranteed Issue
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The requirement that an insurer or health plan accept everyone, regardless of health, income, or age, that applies for coverage and guarantees the renewal of that coverage as long as the premium is paid.
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Guaranteed Renewability
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The requirement that each insurer and health plan continue to renew health policies purchased by individuals as long as the person continues to pay the premium for the policy.
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Health Insurance Unit (HIU)
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Groups of related persons whose combined income would be counted in determining Medicaid eligibility in most states, which is similar to persons who would be able to jointly purchase private insurance.
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Health Maintenance Organization (HMO)
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An entity that offers prepaid, comprehensive health coverage for both hospital and physician services with specific health care providers using a fixed structure or capitated rates.
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HIPAA
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The Health Insurance Portability and Accountability Act (HIPAA), sometimes referred to as the Kennedy-Kassebaum bill, sets a precedent for Federal involvement in insurance regulation. It designates minimum standards for regulation of the small group insurance market and for a set group in the individual insurance market in the area of portability and availability of health insurance.
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Home Health Care
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Rehabilitative and medically necessary health services provided in the home to aged, disabled, sick or convalescent individuals who do not need institutional care, but who do need nursing services or therapy, medical supplies and special outpatient services.
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Long-term Care
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Care given to patients with chronic illnesses and who are required a length of stay longer than 30 days.
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Look back Period
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The maximum length of time, immediately prior to enrolling in a health plan, that can be examined for evidence of pre-existing conditions.
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Medicaid (Title XIX)
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A Federally aided, State-operated and administered program authorized by Title XIX of the Social Security Act which provides medical benefits for qualifying low-income persons in need of health and medical care. Subject to broad Federal guidelines, States determine the benefits covered, program eligibility, rates of payment for providers, and methods of administering the program.
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Medical Expenditure Panel Survey (MEPS)
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MEPS is a nationally representative survey that collects detailed information on the health status, access to care, health care use and expenses, and health insurance coverage of the civilian noninstitutionalized population of the U.S. and nursing home residents.
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Medical Savings Account (MSA)
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An account, often given tax-preferred status, in which individuals can accumulate contributions to pay for medical care or insurance. MSAs differ from Medical reimbursement accounts, sometimes called flexible benefits or Section 115 accounts, in that they need not be associated with an employer.
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Medicare (Title XVIII)
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A federal program that provides basic health care and limited long term care for retirees and certain disabled individuals without regard to income level. Beneficiaries must pay premiums, deductibles, and coinsurance to receive hospital insurance (Part A) and supplementary medical insurance (Part B). Qualified low-income individuals, called Dual Eligibles, may receive assistance through Medicaid to pay for cost-sharing.
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Medicare Assignment Rates
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The percent of providers who accept Medicare fees as full payment.
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Medicare Part A
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The Medicare Hospital Insurance Program (Part A) covers hospitalization, post-hospital extended care, post-hospital home health care, outpatient hospital diagnostic services, drugs, and health supplies, and most other items ordinarily furnished by a hospital or an extended care facility.
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Medicare Part B
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The Medicare Supplemental Medical Insurance Program (Part B) helps pay for medically necessary physician services, outpatient hospital services, and supplies that are not covered by the hospital insurance.
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MEWA
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Under a Multiple Employer Welfare Arrangement (MEWA), a qualified group or association acts in the interest of its employer-members to provide health coverage benefits for their employees.
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Morbidity
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The extent of illness, injury, or disability in a defined population. It is usually expressed in general or specific rates of incidence or prevalence.
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Mortality
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Death. The mortality rate (death rate) expresses the number of deaths in a unit of population within a prescribed time and may be expressed as crude death rates (e.g., total deaths in relation to total population during a year) or as death rates specific for diseases and, sometimes, for age, sex, or other attributes.
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NA
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Not Available or Not Applicable
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Name-to-Code-Based Reporting
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HIV surveillance technique where cases are initially reported by name, but are converted to code after public health follow-up and collection of epidemiologic data.
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National Center for Health Statistics (NCHS)
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NCHS, an agency of the U.S. Department of Health and Human Services, provides surveillance information regarding trends and disparities in health status and health care delivery, and the impact of health policies and programs to help identify and address critical health problems in this country.
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NR
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Not Reported
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NSD
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Not Sufficient Data
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Office of Management and Budget (OMB)
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OMB assists the President of the United States in the development and implementation of budget, program, management, and regulatory policies.
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Point of Service Plan (POS)
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A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs) that allows members to choose to receive either from the participating HMO providers for a flat fee, or from providers outside the HMO's network with a lower benefit level.
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Pre-existing Condition
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Any condition (either physical or mental) for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period immediately preceding enrollment in a health plan. Pregnancy and genetic information about your likelihood of developing a disease or condition without a corresponding diagnosis are not considered pre-existing conditions.
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Pre-existing Condition Exclusion Period
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The time during which a health plan will not pay for care relating to a pre-existing condition.
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Preferred Provider Organization (PPO)
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A type of health plan designed to give enrollees incentives to use health care providers designated as preferred providers, but that also gives partial coverage for services received from other health care providers.
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Prevalence
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The number of cases of disease, infected persons, or persons with some other attribute, present at a particular time and in relation to the size of the population from which drawn.
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Qualified Medicare Beneficiaries (QMBs)
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Qualified Medicare Beneficiaries (QMB) are those entitled to Medicare Part A whose income is below 100% of the federal poverty level (FPL), whose assets' value does not exceed twice the limit for SSI eligibility, and who are not eligible for full Medicaid. Medicaid pays Medicare premiums (Part A, if necessary, and Part B), Medicare deductibles, and coinsurance.
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Qualifying Individuals (QI-1s)
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Qualifying Individuals are those entitled to Medicare Part A whose income is between 120% and 135% of the federal poverty level (FPL), whose assets' value does not exceed twice the limit for SSI eligibility, and who are not eligible for full Medicaid. Medicaid pays Medicare Part B premiums. As this program is not an entitlement and is funded with a fixed amount of money, enrollment may be capped when funds expire.
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Ryan White CARE Act
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The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (Public Law 101-381) provides funding to cities, states, and other public or private nonprofit entities to develop, organize, coordinate and operate systems for the delivery of health care and support services to medically underserved individuals and families affected by HIV disease. The CARE Act was reauthorized in 1996 and 2000.
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Ryan White CARE Act: ADAP
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State-administered AIDS Drug Assistance Programs provide HIV-related prescription drugs to underinsured and uninsured individuals living with HIV/AIDS.
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Ryan White CARE Act: AETC
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The AIDS Education and Training Centers Program awards funding to support a network of regional centers that conduct targeted, multi-disciplinary education and training programs for health care providers of clinical care for persons with HIV/AIDS. There are also several national, cross-cutting components of the AETC program support and complement the regional training centers.
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Ryan White CARE Act: Capacity Building Grants
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The Capacity Building Grants Program awards funding to eligible entities to strengthen their organization and improve their capacity to develop and/or expand high quality HIV primary health care services. Eligible applicants must be public or private nonprofit entities that are or intend to become a comprehensive HIV primary care provider.
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Ryan White CARE Act: Dental Partnership Program
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The Community-Based Dental Partnership Program awards funding for oral health service delivery and provider training to groups working to increase access to oral health care for underserved regions.
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Ryan White CARE Act: DRP
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The Dental Reimbursement Program (DRP) awards funding to assist accredited dental schools, post-doctoral dental programs, and dental hygiene education programs with uncompensated costs incurred in providing oral health treatment to patients with HIV infection.
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Ryan White CARE Act: EIS
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The Early Intervention Services Program (EIS) awards funding to community health centers, family planning grantees, and other providers who offer comprehensive primary care to individuals living with HIV disease.
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Ryan White CARE Act: Planning Grants
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The Planning Grant Program awards funding to eligible entities to aid in the planning and establishment of high quality HIV primary health care services in underserved regions. Eligible applicants must be public or private nonprofit entities that are or intend to become a comprehensive HIV primary care provider.
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Ryan White CARE Act: SPNS
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The Special Projects of National Significance Program (SPNS) awards funding to support innovative demonstration projects that test and respond to the challenge of HIV/AIDS service provision to underserved and vulnerable populations.
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Ryan White CARE Act: Title I
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Provides emergency assistance to eligible metropolitan areas (EMAs) most severely affected by the HIV/AIDS epidemic. Federal funding is awarded on a formula and supplemental basis to EMAs. There are 51 EMAs in 21 states, Puerto Rico, and the District of Columbia. Title I funds may be used to provide a wide range of services including outpatient medical and dental care and case management.
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Ryan White CARE Act: Title II
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Provides grants to all 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and to eligible U.S. Pacific Territories and Associated Jurisdictions to provide health care and support services for people living with HIV/AIDS. Title II funds may be used for a variety of services including home and community based services, continuation of health insurance coverage, and direct health and support services. Title II also funds the AIDS Drug Assistance Program (ADAP)
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Ryan White CARE Act: Title IV
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Funds to support the development and operation of primary care systems and social services for women, infants, children and youth, and the linking of these care systems with HIV research and clinical trials. Services include primary and specialty medical care, psychosocial services, and outreach and prevention services.
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SCHIP
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The State Children's Health Insurance Program (SCHIP) is a state-administered program funded jointly by states and the federal government that allows states to expand health coverage to uninsured, low-income children and, in some cases, other populations that are not eligible for Medicaid.
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Section 1115 Medicaid Waiver
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The U.S. Department of Health and Human Services can approve 1115 waivers, also known as "Research and Demonstration" waivers, to exempt states from particular statutory and regulatory provisions of the federal Medicaid program, allowing for changes in eligibility, benefits, and other areas of their Medicaid programs.
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Section 1915b Medicaid Waiver
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1915(b) waivers, also known as "Freedom of Choice" waivers, allow states to require Medicaid recipients to enroll in HMOs or other managed care plans. The waivers allow states to: implement a primary care case-management system; require Medicaid recipients to choose from a number of competing health plans; provide additional benefits in exchange for savings resulting from recipients' use of cost-effective providers; and limit the providers from which beneficiaries can receive non-emergency treatment. The waivers are granted for two years, with two-year renewals.
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Section 1915c Medicaid Waiver
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1915c waivers, also known as "Home and Community-Based Service" waivers, are intended to waive selected federal requirements for community-based treatment so that states may adjust their individual programs, particularly in the areas of case management, home health aide services, adult day care, and respite care, to best serve the target populations. These waiver programs are approved for three years.
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Skilled Nursing Facility
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A licensed institution (or a distinct part of a hospital) that provides continuous skilled nursing care and related services for patients who require medical care, nursing care or medical rehabilitation services.
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SLMB
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Specified Low-Income Medicare Beneficiaries (SLMB) are those entitled to Medicare Part A whose income is between 100% and 120% of the federal poverty level (FPL), whose assets value does not exceed twice the limit for SSI eligibility, and who are not eligible for full Medicaid. Medicaid pays Medicare Part B premiums.
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Standing Referral
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A managed care process that allows a provider to refer a patient for ongoing visits to a specialist for an extended period of time, such as six or 12 months.
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State Fiscal Year (SFY)
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State Fiscal Year refers to the one year period of time between July 1st and June 30th, except for the following: New York (April 1-March 31), Texas (September 1-August 31), and Alabama and Michigan (October 1-September 30).
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Supplemental Security Income Program (SSI)
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The largest federal means-tested assistance program in the U.S. that provides assistance for low income aged, blind, and disabled individuals, established by Title XVI of the Social Security Act.
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TANF
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Temporary Assistance to Needy Families (TANF) is a State block grant program which assists needy families under certain work requirements and time limits. Title I of the Welfare Reform Act of 1996 converted Federal funding to TANF from the former Aid to Families with Dependent Children program (AFDC).
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Waiting Period
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The time for which coverage is excluded following the effective date of coverage for conditions that manifested or medical advice or treatment received during a period prior to the effective date of coverage (preexisting condition exclusion).
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WHCRA
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The Women's Health and Cancer Rights Act (WHCRA) sets minimum federal standards for coverage of reconstructive surgery following a mastectomy. The law requires group health plans that provide medical and surgical mastectomy benefits to also provide coverage for breast reconstructions, prosthesis, and treatment for physical complications as deemed necessary by the attending physician.
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