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.
BAA - Business Associate Agreement
BH - Behavioral Health
BHCC - Behavioral Health Care Collaboratives
BHO - Behavioral Health Organization
BIP - Balancing Incentive Plan
BMI - Body Mass Index
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
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 This concept has largely been replaced by OPWDD's Care Coordinating Organizations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.
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
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
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.
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
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
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
NCQA - National Committee for Quality Assurance. A national quality measurement and accreditation organization.
NPI - National Provider Identifier
NYeC - New York eHealth Collaborative
OLP - Other Licensed Provider
ONC - Office of National Coordinator for Health Information Technology
OTP - Opioid Treatment Program
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
QE - Qualified Entity
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
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
Tx - Treatment
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
VBP - Value-Based Payment