Acronyms

A


ACA - Affordable Care Act. Also known as the Patient Protection and Affordable Care Act (PPACA), health care reform (HCR) and Obamacare, it is the comprehensive healthcare reform law enacted in March 2010. ACO - Accountable Care Organization. A population health management organization characterized by a payment and care delivery model that ties provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. ACSC or ACS - Ambulatory Care Sensitive Conditions or Ambulatory Care Sensitive AOD (SUD or AOD) - Substance Use Disorder or Alcohol and Other Drug AR - Accounts Receivable




B


BAA - Business Associate Agreement

BH - Behavioral Health

BHCC - Behavioral Health Care Collaboratives

BHO - Behavioral Health Organization

BIP - Balancing Incentive Plan

BMI - Body Mass Index




C


CAHPS - Consumer Assessment of Healthcare Providers & Systems

CAQH - Council for Affordable Quality Health

CAS - Coordinated Assessment System

CBO - Community Based Organization

CCBHC - Certified Community Behavioral Health Clinic

CDS - Clnical Decision Support

CEHRT or EHR - Certified EHR Technology

CFCM - Conflict Free Case Management

CFTSS - Children and Family Treatment and Support Services

CHC - Community Health Center

CMHC - Community Mental Health Center

CMMI - Center for Medicare and Medicaid Innovation. A branch of CMS that develops new payment and service delivery models.

CMS - Center for Medicare and Medicaid Services. Federal agency that governs Medicare, Medicaid, and CHIP.

CPOE - Computerized Provider Order Entry

CPT - Current Procedural Terminology. Billing coding set developed by the American Medical Association.

CQI - Continuous Quality Improvement

CQM - Clinical Quality Measures

CTAC - Community Technical Assistance Center




D


DDP2 - Developmental Disabilities Profile - 2

DEA - Drug Enforcement Agency

DISCO - Developmental Disabilities Individual Support and Care Coordination Organization. A managed care intermediary concept developed by NY state. This concept has largely been replaced by OPWDD's Care Coordinating Organizations

DSM-V - Diagnostic Statistical Manual, Version 5

DSRIP - Delivery System Reform Incentive Payment (DSRIP) Program. A NY statewide program to improve quality and patient experience while delivering more efficient, affordable care.




E


EBP - Evidence-Based Practice

eCQMS - Electronic Clinical Quality Measures

ED or ER - Emergency Department or Emergency Room

EDI - External Data Interchange

EHR / EMR - Electronic Health Record / Electronic Medical Record. Electronic medical information and other data relating to a patient’s health. Records often include information about a patient’s demographics, insurance coverage, medical history, medications, progress notes, services received, laboratory results, immunizations, and allergies.

EPSDT - Early and Periodic Screening, Diagnostic, and Treatment. A benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.

eQARR - Electronic Quality Assurance Reporting Requirements. DOH system for annual reporting of managed care performance.

eRx - e-prescription or e-prescribing




F


FFS - Fee-for-Service. Payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.

FIDA - Fully Integrated Duals Advantage. The technical name for the CMS demonstration program to integrate managed care for individuals with both Medicare and Medicaid coverage.

FIDA-IDD - Fully Integrated Duals Advantage for individuals with developmental disabilities

FQHC - Federally Qualified Health Center




H


HARP - Health and Recovery Plan. NY specialty managed care organizations that cover specialty behavioral health services for select populations with intensive behavioral health needs.

HCBS - Medicaid Home and Community-Based Services

HCPCS - Healthcare Common Procedure Coding System. Another Health Care Code Set (Acronym pronounced “hick picks”)

HEDIS - Healthcare Effectiveness Data and Information Set

HHTS - Health Home Tracking System

HIE - Health Information Exchange

HIT - Health Information Technology

HITECH - Health Information Technology for Economic and Clinical Health Act

HMO - Health Maintenance Organization

HUB - Care coordination, centralized information and referral.




I


ICD-10 - International Statistical Classification of Diseases, Version 10. Code set developed by the World Health Organization.

ICDS - Integrated Care Delivery System

IDT - Interdisciplinary Team

IOP - Intensive Outpatient Program

ISPM - Individualized Service Planning Model




L


LGU - Local Governmental Unit

LOC - Level of Care

LOCADTR - Level of Care for Alcohol and Drug Treatment Referral

LTC - Long-Term Care

LTSS - Long-Term Services and Supports




M


MAPP - Medicaid Analytics Performance Platform

MBHO - Managed Behavioral Health Organizations

MCO / MCP - Managed Care Organization / Managed Care Plan. Health insurance plan that offers health services to its members, and offers financial incentives for patients to use the providers who belong to the plan. Examples include: HMOs and PPOs.

MCTAC - Managed Care Technical Assistance Center

MLR - Medical Loss Ratio

MLTC - Managed Long-Term Care

MMIS - Medicaid Management Information System

MRT - New York Medicaid Redesign Team

MSC - Medicaid Service Coordination / Coordinator

MU - Meaningful Use




N


NCQA - National Committee for Quality Assurance. A national quality measurement and accreditation organization.

NPI - National Provider Identifier

NYeC - New York eHealth Collaborative




O


OLP - Other Licensed Provider

ONC - Office of National Coordinator for Health Information Technology

OTP - Opioid Treatment Program




P


PA - Prior Authorization

PAHP - Prepaid Ambulatory Health Plan

PCCM - Primary Care Case Management

PCMH - Patient-Centered Medical Home. A model of care intended to put patients at the forefront of care.

PH - Partial Hospitalization

PHP - Partner's Health Plan. The single managed care plan for New York’s FIDA-IDD.

PHRs - Personal Health Records

PIHP - Prepaid Inpatient Health Plan. A type of managed care arrangement that provides prepaid capitation payments to managed care entities that arrange for inpatient hospital care.

PMPM - Per Member Per Month

PPO - Preferred Provider Organization. A managed care organization that has a more limited provider network; services obtained from outside the network are not covered or feature higher cost-sharing levels.

PPS - Performing Provider System

PROS - Personalized Recovery Oriented Services




Q


QE - Qualified Entity




R


RCM - Revenue Cycle Management

RFA-RFQ-RFP - Request for Application, Qualifications, Proposal

RHC - Rural Health Clinic

RHIO - Regional Health Information Organization. Facilitate exchange of health-related information among multiple stakeholders.

RPC - Regional BH Planning Consortium




S


SDE - State Designated Entity

SED - Seriously Emotionally Disturbed

SHIN-NY - Statewide Health Information Network of New York

SNP - Special Needs Plan

SPA - State Plan Amendment

SPMI or SMI - Seriously and Persistently Mentally Ill or Seriously Mentally Ill

SUD or AOD - Substance Use Disorder or Alcohol and Other Drug




T


Tx - Treatment




U


UB-04 - Uniform Bill, Version 4. Claim form, also known as the CMS-1450 form

UM - Utilization Management

UR / UM - Utilization Review / Utilization Management

URAC - Utilization Review Accreditation Commission




V


VBP - Value-Based Payment





ABOUT US

The Managed Care Community of Practice in I/DD is a project of the New York Alliance for Inclusion & Innovation.

 

The project is presented in partnership with Manatt, Phelps & Phillips, McSilver Institute for Poverty Policy and Research at New York University, Negri Management Resources, New York Alliance for Inclusion and Innovation, and Vorys Health Care Advisors.

CONTACT

518-795-3590

 

mccop.info@nyu.edu

DISCOVER

© 2018 by Managed Care Community of Practice.