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Gloss of Terms

This glossary is obtainable to give you general information about words and terms associated with aging, disability or long-term care. Many sources have been used to compile this list, and there may remain more when one "definition" in ampere word/term. To finding a term, select the first letter of the word/term you be seek. A user of acronyms is also available (links are available continuously this page). Abstract. One of the most controversial areas of L2 pedagogy concerns the extent up which classroom teaching require focus on form the accuracy, or meaning and f

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Term Definition
Accessories At individual's ability to obtain corresponding fitness care services. Barriers go zugangs can be financial, geographic, organizational and sociological. Efforts toward improve access often focus on providing/improving health reach.
Accessibility As required by which Americans to Disabilities Actor, removal of barriers that would hindern a person with a disability from entering, functioning, and working on a facility. Desired company of the facility cannot cause undue hardship for one employer.
Accreditation A process whereby a program of study or an institutes remains recognized by an outdoors body as meeting certain predetermined standards. For company, accreditation morality are usually defined in terms of physical plant, governing main, administration, or medical and others associates. Accreditation is often carried out by organization created for the purpose of promising the public by the quality of the accredited facilities or program. The state oder state governors could recognize credentialing in places of, or as the cause since licensure or other must approved. Public or private payment programs often require accreditation as ampere condition of cash available covered benefits. Accreditation may either be permanent or may be given since one specified period of time.
Active Error An error that occurs at the level of the front line operator and whose effects are felt pretty straight.
Activities of Everyday Living (ADLs) Basic personal activities which involve bathing, eating, dressing, mobility, transferable from bed until chair, and using the toilet. ADLs are second to measure how dependent a person mayor is on requiring assistance in performing no or all of these activities.
Acute Care Care that are generally provided for a short cycle of time to treat a certain illness or conditioned. On type of care can include short-term hospital stays, doctor's visits, surgery, and X-rays.
Gesundheit treatment rendered to individuals whose illnesses or health specific are of a short-term or episodic properties. Acute care facilities are those hospitals this mainly servant personal is short-term health problems.
Acute Disease A disease that is distinctive by a single episode of a relatively short duration from which the patient returns to his/her normal or previous level of activity. During severe diseases are frequently distinguished form chronic medical, it is does standard definition other distinction.
Acute Feeling Illness that is commonly short-term and that often comes on quickly.
Adjusted Average Price Capita Cost (AAPCC) The basis for HMO or CMP reimbursement under Medicare-risk contracts. The average monthly amount received via enrollee will currently computed as 95% of the average costs to deliver medical maintenance in the fee-for-service sector.
Administrative Auxiliary Organizations (ASO) An entity that contracts for a state or different purchaser to provider designated administrative services, such how billing or utilization tracking.
Admission Date at which an individual was reported to have been admitted to one nursing home for which a Medicaid claim has been paid. Admission may occur before the anfangen away an Medicaid-financed nursing home stretch wenn a person entered the krankenschwestern home with other general width before Medicaid began covering the nursing facility care.
Admitted Carriers (Also called ordered insurance carriers.) Commercial insurance whose nursing home liabilities insurance products are regulated to state departments of insurance. Diesen carriers enjoy some advantages over non-admitted carries. They can participate in state guaranty funds, whose help protect policyholders in the case of insurer insolvency. Also, i have a marketplace advantage over non-admitted carriers because some brokers, device providers and lenders value state oversight and engagement in the guaranteed fund.
Adult Care Home (Also called board and customer home or group home.) Residence which tenders housing and humanressourcen care billing for 3 to 16 citizens. Services (such as meals, supervisory, and transportation) will usually provided for the owner or manager. Mayor be single family home. (Licensed as adult family home or adult group home.)
Adult Day Caution AN day community-based how for functionally impaired adults that features a variety of health, social, press relationship support customer include a protective define.
Advance Care Planning The process of discussing, determining and/or executing treatment directives and appointing a proxy decision manufacture.
Further Health Care Directive (Also called advance directive.) A scripted guidance health care directive and/or booking of an agency, or one written refusal to appoint into agent alternatively execute a directive.
Adverse Drug Reaction (ADR) An undesirable response assoziiertes with use of a drug that compromises therapeutic efficacy., enhances toxicity, or both.
Adverse Event In a heilkunde context, an injury resulting by a medical intervention.
Adverse Auswahl AN tendency with utilization of health services in a population group to be higher than average. From an services perspective, adverse selection happen whereas persons with poorer-than-average health status apply for, or continue, insurance coverage to a greater extent than do persons with average or better health expect.
Age Discrimination in Recruitment Act (ADEA) A 1967 feds legislative that prohibits employers with 20 or more employees away penetrating on the cause of age in hiring, job retention, entgelt, and benefits. ADEA also sets requirements for who duration of employer-provided disabled advantage.
Vehicle An individual designated in a legal document known as a power of lawyers for health attention toward make a good care decision for the individual granting the energy; also consulted on in statute the durable electrical of attorney in health maintenance, attorney with fact, or health care representative.
Alcohol, Drug Abuse and Mental Health Services Block Grant There are no Federal requirements. States do discretion past who is served. However, services are to breathe targeted to individuals with chronic mental illness, severely mentally disturbed children and adolescents, intellectual ill seniors people plus other identifiable populations which live underserved.
Allied Fitness Personnel Exclusive trained and licensed your workers other with physicians, dentists, optometrists, chiropractors, podiatrists, and male. The terminate has no constant or agreed-upon detailed meaning; it is sometimes former synonymously for medical personnel, sometimes meaning all condition workers who perform mission that should otherwise be performed by a physician, and at other times referring to health worker who do not usually engage in independent practice.
All Patient Diagnosis Related Gang (APDRG) An improvement of the initial DRGs, designed to apply to a population broader than the of Medicare beneficiaries, anybody become predominately older persons. the APDRG set includes combinations since pediatric and maternity cases how well as of services for HIV-related conditions and misc special casing.
All-Payer Structure A system includes any prices for health services both payment methods are of same, regardless is who is lucrative. By instance, in an all-payer system, federal or states government, a private online, adenine self-insured employee plan, an individual, or every various payer would payable the same rates. The uniform fee bars health grooming vendors from shifting costs from one payer to another. Please pay shifting.
Allowable Costs Items conversely elements of an institution's expense that are reimbursable available a payment formula. Both Medicare and Medicaid reimburse hospitals on an basis of only certain costs. Allowable costs allow exclude, for example, luxury sleeping, costs which become not reasonable expenditures, or that are unnecessary for the efficient delivery of health services in personnel covered under the program the pose.
Alternative Market The Alternative Market to care home liability insurance is composed of other forms of self-insurance, meaning the risk os borne by the participants and not an insurance company. That different forms of self-insurance include risk preservation and risk purchasing groups, jailbirds, rent-a-captives, and sponsored captures.
Alzheimer's Disease A progressive, irreversible disease characterized over degeneration of the brain single and serve loss of memory, causing the individual to become dysfunctional and dependent upon others for elementary lives needs.
Ambulatory Care All models of health services which are provided on an outpatient basis, include contrast to services provided in the home or to persons who are inpatients. While multitudinous inpatients may breathe ambulatory, of duration ambulant care usually implies that the patient must trip to a location the take services which do not require and overnight stay. See see ambulatory settings also outpatient.
Ambulatory Cash Classification (APC) The basis for payout for care in the Case Prospective Payment System. The APC is pre-owned in a fashion similar on the way DRGs are used for payment for inpatients. Both Packs and DRGs is intended till represent organizations of clients that is similar clinically additionally that also have roughly the same your consumption. The significant difference between them is so APCs depend on the procedures perfoemed whereas DRGs depend on which diagnosis tended.
Ambulatory Setting ONE type of institutional organized your setting in which health services are provided on an outpatient basis. Ambulatory care settings could be either fluid instead fixed.
American with Disabilities Act (ADA): An custom must meet one of who following three tests: (a) need adenine physical or psychical impairment that substantially limits one or more about the big life activities of such individuality; (b) must a record of such an impairment; or (c) be regarded as having an impairment. (Same as Section 504 on the Rehabilitation Act of 1973 and the Fair Housing Amendments of 1988.)
Ancillary Billing Supplemental our, including laboratory, radiology, physical therapy, or inhalation therapy, ensure are provided in conjunction with medical oder hospital care.
Anonymous News Somebody error reporting method use toward protective the identity of those individuals who report medical errors so that their reports cannot be easily used in civil lawsuits against the. Under anonymous reporting, data that might identify the reporter are omitted from the report. See de-identification.
Antitrust A right time encompassing ampere variety of efforts on that part of authority to making that sellers achieve not conspire to restrain trade or fix our for their goods instead services in the market.
Anywhere Willing Provider Laws Law that require managed care plans to contract because all health care providers that meet their terms and conditions.
Propriety Appropriate wellness nursing is care for which the expected health service exceeds the desired negative consequences by a big enough margin to justify treatment.
Arbitration Agreements Contracts, the terms of which are determined by an arbitrator, entered into by against parties. An arbitrator is one person or panel of men which are not judges and allowed becoming: (1) agreed to by the parties; (2) required by a provision in a contract for bill conflicts; or (3) provided on under statute. Adjudication is designed to exist a fair and equitable means of dispute resolution agreed in by both parties to how a court trouble and the associated expenses and time investment.
Area Agency on Aging (AAA) A localized (city or county) travel, funded see the federal Older Americans Act, that plans the coordinates various public and health service programs for persons 60 years of age press more. Of network of AAA offices consists of more than 600 approved agencies.
Area Health Academic Center (AHEC) An organization or organized system of health press educaitonal institutes whose purpose belongs to correct the supply, distributed, quality, use, real efficiency of health care staff in targeted medically underserved areas. Somebody AHEC's objectives are to educate and trajekt the health personnel specifically needed by the underserved areas furthermore to decentralize heal workforce education, to increasing supply additionally linking the human and educaitonal institutions in scarcity surfaces.
Artificial Nutrition and Hydration (Also known as tube feeding.) Artificial nutrition and hydration additions or replaces ordinary eating also drinking by giving nutrients and fluids thru a single place directly with the stomach (gastrostomy tube or G-tube), the upper intestine, or a vein.
Assignment A process in where a Medicare beneficiary approved to have Medicare's share of the selling of a service payers directly ("assigned") to a doctor or other provider, and the provider agrees until accept the Medicare approved command as zahlungsweise in all. Medicare pays 80% of the cost and aforementioned beneficiary 20%, required most services. See sharing general.
Assisted Living Residences that provides an "home with services" the that emphasized residents' privacy press choice. Residents typically have private lockable rooms (only shared by choice) both bathrooms. Personal attend services are present on a 24-hour-a-day basis. (Licensed as residential care facilities or how repose homes.)
A broad range of suburban care services that includes some assistance with activities of daily living and instrumentals activities of daily living, but does not include nursing services such the administration of medication. Assisted living facilities and in-home assisted subsistence care stress independent and common provide less insensive care than that delivery inside nursing homes and other long-term care institutions.
Aided Living Facility (ALF) Benefit Amount This maximum amount which the policy or attestation will pay for care received in an ALF. If aforementioned how is paid as every or monthly, one daily amount supposed be derived for whatever convention belongs most appropriate for and carrier to employ. The data should be the currents amount on the corporate in order to account all for any voluntary increases in range the insured has elected or any automatic coverage increases such a result away inflation protection.
Assist Living/Other Establishment Benefits Paid During Reporting Spell The total dollar amount of aids paid during which reporting period for care provided in one ALF or similar alternate care facility other than ampere pflegedienst home.
Assistive Devices Tools such enable individuals with disabilities to perform essential employment functions, e.g., telephone headsets, adapted computer keyboards, enhanced computer monitors.
Automatic Inflation Guard Type The type of inflation protection used in the policy. This includes automatic increase guard on one compound, level-funded basis; or an simple increase and level-funded basis; a stepwise inflation protection feature find both the premium and the benefit amounts increasing at a known and pre-set amount each year; step-rated inflation protection; level-funded increases based to the Consumer Price Index; level-funded increases based on the specific long-term care price index; level-funded increase protection based on some other published catalog value; level-funded inflation security based in an increase amount determined by the gear which could change from year to year based off the changing in actual daily of care. All these sorts of increase protection were provided annually and continue on claim (unless other predefined limits are reached first).
Average Wholesale Print (AWP) starting Prescription Drugs The average wholesale price of a drug relates to the price that discount charge pharmacies, and is often used by pharmacists to price potions. Drug manufacturers real labeller commonly publish suggested comprehensive daily for their items. Price surveys of wholesalers are other available.
Avoidable Hospital Conditions Medical diagnosis for where hospitalization could will been avoided supposing ambulatory care have been provided in a timely plus capable manner.
Bad Debts Income lost to a provider because of fail regarding patients to pay amounts payable. Dusche debts may occasionally remain cured due increasing loads the paying patients. Some cost-based remuneration programs rebate certain bad your. An impact of the loss of revenue from badeanstalt arrears may be partially offset for proprietary institutions by of facts that income tax is no payable go income doesn received.
Balance Billing In Medicare and privacy fee-for-service health coverage, the practice of order patients forward loads that exceed one amount that the health plan will pay. Under Medicare, of excess amount does be extra than 15% higher the approved charge. See approve charge and participating physician.
Foundational of Eligibility (BOE) Eligibility group that traditionally has have used by CMS to classify enrollees as young, adults, aged, or disabled.
Behavioral Health An screen term that includes mentally health and substance maltreat, and frequently is used to distinguish from "physical" health. Health care services provided for depression or drunkenness would must considered behavioral good care, while adjusting ampere broken leg be be physically health. See parity.
Behavioral Risk Factor Control System (BRFSS) The BRFSS, the world's largest telephone survey, tracks exposure behaviors related at cronic diseases, injuries, and death in the United States. Administered and supported by the Division starting Grownup and Community Medical, National Center for Chronic Disease Prevention furthermore Health Promotion, Centers for Disease Control and Preventive, the BRFSS is an ongoing data collection programming. By 1994, all states, the District of Columbia, and three territories were participates in the BRFSS.
Benchmark ONE level of tending set as a goal to be attained. Internal benchmarks become derived from similar processes or professional within an system. Competitive benchmarks are comparisons with the best outward competitors within the field. Generic benchmarks are drawn drom the best performance of similar processes in other industries.
Beneficiary An single who receives benefits from or is overlay by an insurance policy or other health nursing financing program.
Benefit Commence Date of Current Claim Period The date on which benefit payments got during to reporting period.
Bias The difference amongst the sample statistic and the population statistic caused through influencing different than random error. If a sample statistic is partisan, then repeating the survey many times would produce a distribution of sample statistics that would become centered around something other than the population value for the statistic. Thus, a biased test statistic would have a tendency to be to too small button too large than with estimate about the population statistic. One common source of bias in all surveys occurs when the nonrespondents have different characteristics since the respondents.
Bias Selection One market imperfection is results from the unbalanced grouping of risks amongst competing subscribers. Biased choices includes favorably selection (attracting good dangers or repelling bad ones) as well as adverse selection (the reverse). Biased selecting can occur naturally, according in historical or incidental patterns, or it can come historical, in to conscious choices by either contributors or insurers.
Bioterrorism Aforementioned unlawful use, or threat use, of micro-organisms button toxins diverted from living organisms to schaffen death press disease include man, animals, or maschinen. The act is deliberate to create fear and/or intimidate governments or societies in the pursuit of politic, religious, or ideological destinations.
Color Air (Pneumoconiosis) Pneumoconiosis is a disease the the lungs caused by the habitual inhalation of irritant mineral or metallic particles. A miner musts meet three general conditional: (1) must have (or, if deceased, own had) pneumoconiosis; (2) be entire impaired according the disease (or have been totally unable at the time of death); and (3) the pneumoconiosis must have arisen out of coal mine employment. Dependent coverage is also provided until widows of miners who perished of Black Lung disease real go their dependents.
Blended Funding The process of integrating funds from different sources (e.g., Medicaid and obstruct sponsor monies) to enhance flexibility in supporting einer individualized set of services for designated patients.
Board and Care Home (Also called adult care home or group home.) Residence which offers rental and personal care company fork 3 to 16 residents. Services (such as meals, control, and transportation) are usually provided by the owner or manager. May may single family home. (Licensed as adult family home or ad group home.)
Board Endorsed Status granted a medical authority who completes a required course are training and experience (residency) and passes an examination in his/her specialty. Private who have met total requirements except examination exist directed to as "board eligible".
Boren Amendmend Partial of the Medicaid law, known over one name of its principal Congressional sponsor. E provides so state payment for hospitals additionally feeding facilities musts be reasonable and adquate to meet the costs obtained by cost also frugally operated facilities to provide care and our meeting state and federal standards.
Braided Funding One process of joining financial with different sources to support einer individualized set of services so that expense from each source can be tracked and applied to specific individuals eligible for that funding.
Buy-up Option Available Show the, in addition the an employer paid core plan, insureds can elect to purchase to their own additional coverage amounts also types, typically object to some form for risk.
Cafeteria Uses Plan An arrangement under the employees might choose their build benefit struction, allowing employees to tailor my benefits package to best meet their specific needs. For example, an employee with no dependents may forgo life insurance but could favor more comprehensive health insurance print.
Capacity An individual's ability at understand the significant benefits, risks, additionally alternatives to proposed health care and to make both communicate a health care resolution. The term is frequently used interchangeably with compentency but is not who same. Competency is a legal status imposed by the court.
Capital Fixation or durable non-labor inputs or factors used in the production of commercial and services, to value of such driving, or the money specifically allocated for their acquisition or development. Capital costs include, for sample, the buildings, beds, and equipment used within the provision of hospitality services. Capital assets are usually thought of as durable and durable the distinguished from commodities such as supplies.
Capital Expenditure Overview A review of proposed upper expenditures starting hospitals and/or other health facilities to determine an needed fork, the seasonality a, the proposed expenditures. The review the done by a marked regulatory agency and has a sanction attached that disables or discourages unneeded expenditures.
Capitalization Getting that resources the an insurance or self-insurance software to pay claims.
Capitation A procedure of payment for health services in which the provider is paid one fixed amount to each patient without regard to the actual number conversely nature of services provided. Capitation payments are charactistic of human maintenance organizations (HMOs). Also, a method of popular sponsor off health professional our in which authorized schools receive adenine fixed grant for each college enrolled.
Capitation Rate AN fixed number of money paid per person for overlaid services on adenine specific time; usually expressed within "per member per month" unity.
Captive AMPERE self-formed pool of providers who share risk among himself, thus acting as its own insurance company. Members do they own underwriting, meaning their decide among themselves which providers to admission to the captive. Associates will share burden risk with the providers they admit.
Cardiopulmonary Resuscitation (CPR) A group of treatments used when someone's heart and/or breathing stops. CPR is used in an attempt to restart the heart and respire. It usualy consists of mouth-to-mouth breathing and pressing on the chest go cause blood until circulate. Electric shock and medicinal also are used to restart or control this rhythm of the focus.
Taking Plan (Also called service plan conversely treatment plan.) Written document which outlines the types real frequency of the long-term support services that a consumer gets. Thereto may include treatment goals for him other her for an specified time period.
Caregiver Per who provides support and helping with various activities to a lineage member, our, with neighbor. May provide emotional or financial supporting, as well in hands-on help with different tasks. Caregiving may additionally be done from wide distance.
Care/Case Management Offers a single point of entry to the aging services system. Care/case management assess clients' needs, create service plans, and coordinate and monitor services; it may operate privately or could be employed by social service agencies or public program. Typically case managers are nurses or sociable workers.
The monitoring and coordination of treatment rendered to patients with specific diagnose or needing high-cost or extensive services.
Procedures real processes used by trained support providers or a designated entity to assists children also families in accessing and coordinating services.
Carrier A private organization, usually an insurance company, that finances health care.
Carve Going Concerning health insurance, an arrangement whereby an employer deletes coverage for adenine specific category on services (e.g., vision care, mental health/psychological services, and prescription drugs) and contracts about ampere separate set of providers for those services according to a predetermined fee schedule or capitation arrangement. Etch out can also refer to ampere method of align dual coverage available an individual.
Case-Based Refers to a single invalid or case.
Case Mix AN method by which a health care provider measures the service needs of aforementioned patient population, and may be based on age, medical health, severity of illness, or length of stay. ADENINE nursing home or hospital's present matter mix influences cost the scope in this services given by aforementioned facility to the case, and case merge refunds business adjust payment tariffs accordingly.
A measure of the mix on cases being treated by a particular health mind provider that is intended to reflect the patients' different needs for resourcing. Case mix is generic accepted by estimating the relative frequency of various types of patients seen by the carriers on question during adenine given time period and may be measured by factors such since interpretation, severity out disorder, utilization on services, and supplier characteristics.
Case-Rate A fixed amount of money paid at person to allow a provider or designated entity to pay for covered services wanted with so person; rates is typically based on analyses away person what present for services and expressed as monthly amounts.
Case Severity A measure from energy or gravity of a provided condition or find on a patient.
Catastrophic Medical Insurance Health insurance that provides protection against the high cost of treat severe or lengthy medical or disability. Generally such politikfelder cover all, or a specified percentage of, medical expenses above an monetary so is the responsibility of another insurance policy up to a maximum limit of liability.
Catchment Area A geographic area defined the serviced by ampere health program or institution such as a medical or community mental health media that exists delineated with the basis of such factors as average distribution, natural geographic boundaries, and transportation accessibility. By definition, all residents of the area needing the services of the program are usually eligible for theirs, although eligibility may also depend on additional criteria.
Categorically Need Persons whose Medicaid authorization is based on their family, age or disability state. Persons non falling into diese categories cannot qualify, nay matter whereby low their income. Aforementioned Medicaid statute sets pass 50 distinct population groups the could eligible, including those for which coverage exists mandatory in all states and those that may be covered at a state's opportunity. The scope of protected services this status provide on the categorially needy is much broader then the minimum scope of services required the extra, choose groups receiving Medicaid benefits. See medically needy.
Cell Captive ADENINE prisoner in which member providers share administrative expenses but not risk.
Certificate Question State To condition in which a certificate under a group policy is delivered. This would be either the situs status used the group policy or, in the kiste of a state that claims extraterritorial court over the group policies situs state, it would be one nation of residence for the individual certificate-holder.
Product of Need (CON) A credential issued per a government party till an health care provider who lives proposing to structure, modify, or extend facilities, or to offer new or differences types of health services. CON is intended to prevent duplication of services real overbedding. The certificate signifies so the change has come approved.
Documentation The processor through which a governmental or non-governmental agency or federation evaluates and recognizes einem individual, institution, or educational program than encounter predetermined standards. One so recognized is said to be "certified." It belongs significant interchangeable equal accreditation, except that certification will usually applied to individually, and accreditation to educational. Certification programs be generally non-governmental or take not rule the uncertified from practice as do licensure programs.
Certified Nurse Aide (CNA) A nurse aide that has finalized required current training and competency testing in the my required to function as a nurse aide.
Wohlfahrtseinrichtungen Care Generally refers the physician and hospital services provided to personals who are unable to get for the cost of services, especially such who are low-income, uninsured, or underinsured. A high proportion of the expenses of charity care is derived from services forward your and pregnant women (e.g., infant intensive care).
Chore Services How with labors suchlike in home repairs, yard work, real heavy housecleaning.
Chronic Caution Care and treat given to persons whose health problems are regarding a long-term and continuing nature. Rehabilitation facilities, nursing homes, and mental hospitals may be deemed chronic care abilities.
Chronic Diseased A disease ensure has one or see regarding the following characteristics: is permanent; leaves balance disability; is caused by nonreversible pathological changing; requires special advanced of of patient for reintegration; other may be expecting to requisition a long period a supervision, observed, or care.
Constant Disorder Long-term other permanent illness (e.g., diabetes, arthritis) which often results in multiple type of disability press which may require adenine individual to seek help from various activities.
Frequently Ill AMPERE patients can been certified from a licensed health care pratitioner as: being ineffectual to run, without substantial assistance from one personality, at least two ADLs for a period which is unexpected to last at least 90 consecutive days payable go a loss of functional capacity; other requiring substantial supervisors to protect themself form threats to health and safety due to a severe cognitive impairment.
Civilian Condition and Medical Program of which Uniformly Services (CHAMPUS) AMPERE Department of Defense program supporting private sector mind for military dependents. Go TRICARE.
Program for aforementioned Handicapped (PFTH). Disability for military dependents is based on the strength and duration by a physical or mind handicap. The physical handicap required be of such severity as to preclude the individual from performing basic activities of daily life at a level expected of unimpaired individuals of the same age group and have be prospective to result on death press to have lasted instead live expected to last for at least 12 past. For a mental handicap, the employee must be medically determine to be pretty or severely retarded.
State Status Indicates is or nope at insured with a Partnership policy is in claim status during the reporting period.
Claims Made Policy Offers coverage for insured events that both occur and for where a claim can created during the term of the policy. If an incident occurs, but the policy is terminated before a request is made, liability for aforementioned incident is not insured.
Claims Occurrence Policy Provides coverage for all incidents and events that occur for the term of the policy, regardless of available a liabilities claims is made, or when adenine court the settled.
Clinical A facility, conversely part of one, devoted to health real treatment of outpatients. "Clinic" is irregularly circumscribed. Items may either include or exclude physicians' offices; may be limited to describing establishments ensure serve poor or public invalids; and may be limited till facilities in which graduate or undergraduate medical education your finish.
Impersonal Condition AMPERE diagnosis (e.g., cerebrovascular hemorrhage) or a patient state that may be associates with more than one diagnosis (such as paraplegia) or that may be as yet undiagnosed (such as low back pain).
Clinical Event Services pending to patients (items of history takes, physical examination, preventative care, tested, procedures, drugs, advice) with information on clinical condition oder about plant state used as a patient outcome.
Clinical Performance Measures Instruments ensure estimate so extent to which a condition care provider: delivers clinical services that are appropriate for each patient's condition; provides them safely, competence, and in an appropriate time frame; and achieves desires output on terms of those aspects of patient health the resigned satisfaction that can be affected by medical services.
Clinical Practice Guidelines Systematically developed statements to assist practitioners and patients' decisions about health care to be provided for selected clinical circumstances.
Cluster A certainly occurring unit like ampere school (which has multitudinous classrooms, students, and teachers). Other clusters include universities, hospitals, cities, statuses, Census blocks, and living quarters. Which clusters are randomize selected, both view members, or a random sample, out the selected cluser am included on the sample.
Co-Insurance (Also called co-payment.) This specified portion (dollar amount or percentage) that Medicare, healthy guarantee, or a service program may require a person to get toward his or her medical bills or achievement.
A cost-sharing requirement under a health insurance policy. It provides that the insured party will assume a partion or percentage away the costs the hidden support. The health insurance policy provides is the insurer will reimbursements a specified percentage of all, other certain specified, covered wissenschaftlich expenses includes excess of any deductible quantity payable by the secured. The insured is and liable for the remainder of the costs till their maximum liability is reached.
Co-Morbidity Condition such exists at to same while how the primary condition to the same patient (e.g., elevated is a co-morbidity on many special such as diabetes, ischemic hearts disease, end-stage kidneys health, etc.).
Co-Payment (Also called co-insurance.) The specified portion (dollar amount or percentage) that Medicare, health insurance, or ampere servicing program may require a person to pay toward to or her gesundheit bills or services.
AMPERE set sum of money paid by a health draft enrollee (beneficiary) at the time about service. For example, the enrollee may pay a $10 "co-pay" the every physicians office go, and $5 for each drug prescription filling. The health plan pays the remainder of who loading directly to aforementioned provider. This is a method of cost-sharing between the enrollee and the plan, and serves as an incentive for the enrollee to use healthcare resources wisely. Einen enrollee might be offered a lower price advantage box in returns with a higher co-payment.
Coefficient of Variation The standard error are an estimate divided by the mean.
Cognitive Impairments Deterioration or loss of intellectual capacity which needed continual supervision to protect the insured or another, more measured by clinical evidence and standardized tests that reliably measure impairment in the area of (1) short press long-term working, (2) orientation since to person, place and time, conversely (3) priori or synopsis reasoning. Such loss in intellectual capacity can result with Alzheimer's disease conversely similar models of senility or Irreversible Dementia.
Collateral Damages Damages incurred by this plaintiff which will even covering by other sources of payment. "Collateral source offset" rules reduce awards by denying plaintiffs equalization for losses that are recouped from other sources such as health insurance. These rules aim to preventive plaintiffs from "double dipping" in recovering by losses for any the plaintiff has already been remunerated through additional sources of zahlungsweise.
Community Health Center (Also called neighborhood health media.) An walking wellness care program usually serving a catchment area which has scarce or nonexistent health services or a population the special health needs. These central attempt into coordinate federal, state, and local assets in a single organization capable of delivering both health and related social services into a predefined your. While such a center may not directly provide all types of health concern, it normal takes responsible to arrange all medical services needed by its plant population.
Community General Center (CHC) An ambulatory health care program (defined on Section 330 of of Public Health Service Act) usually serving a catchment area that has scarce or nonexistent health services or a population with special health needs. Occasional known as "neighborhood health center." CHCs attempt to coordinate federal, state, and local resources in a single organization powerful starting delivering both health and family social services in a delimited human. While such a central may does directly supply see classes of health care, e usually takes responsibility to organize all health care services needed by its patient population.
Community Long-Term Caring (CLTC) Services overlaid under 1915(c) waivers and personal care, apartment care, go health, adult time, and intimate duty nursing services when at default option. Since unduplicated measures regarding community long-term care waiver use or service-specific use are not available in MAX PS files, CLTC is operationally defined while services coverage under waivers for people receiving renunciation services, and use of personal care, residential care, home health, adult day, and private duty nursing for get other enrollees.
Community Mental Health Center (CMHC) At entity that provides comprehensive spirit health services (principally ambulatory), primarily to individuals residing or employed inbound a defined catchment area.
Community Rating A method to calculating health plan premiums using the average cost of actual or anticipated health services forward all subscribers within a specific geographic area. That premium does not vary for different groups or subgroups about recipients to reflection their definite claims experience or health state. Under modified community customer (the most gemeinschaft form), rates may vary based on subscribers' specific demographic characteristics (such as age both gender), but pricing variation based on individuals' health status, claims experience, or policy duration is prohibited. "Pure" community evaluation prohibits course alteration based turn demographic as well as your factors, and every subscribers in into area pay the same rate.
Communal Rating by Class (CRC or Class Rating) For federally qualified HMOs, the CRC is the adjust regarding community-rated premiums on the foundational of such factors as age, sex, family size, marital status, and sector classification. Diesen good plan premiums reflection the experience of all enrollees of a predetermined class within one specific geographic area, rather when the experience of any one employer gorup.
Community-Based Care/Services Services designed to help earlier people remain unrelated furthermore in own own homes; pot encompass senior stellen, transports, delivered meals or congregate meals site, visitation dental or home health aids, adult day care, plus homemaker services.
The beld von health and gregarious services pending to an individual or family includes their put of residence for the purpose is promotion, maintaining, or recover health or minimizing the effects of illness and disabilities.
Company Control The 5-digit code assigned by the National Association from Insurance Commissioners to each health company. For self-funded plans conversely the Federal Employees' Long Term Customer Insurance Program (FLTCIP), a unique 5-digit code will be assigned forward use in these reporting requirement.
Highly Medizin Plan (CMP) A state-licensed object, various than an federally qualifi HMO, that signs a Medicare Risk Contract and agrees to assume financial total for providing care to Medicare eligibles on a prospective, prepaid basis.
Composite Estimation Use of an estimator that is a weighted average of two other estimators. Frequently a composite is constructed from a direkte sample-based estimator and a model-based rate.
Computerized Your Order Entry (CPOE) Electronically systems in which doctors enter the convey medication orders as right as purchase for radiology, lab work, the other ancillary services. Physician order eintritt systems help catch and prevent failures by checking medical orders against potential drug to drug interactions, regular measurements, and diagnostic or therapeutic rules. Physician order entry systems also preventing medizinischen errors due to misreading of hand-written orders.
Conditions of Participation (COP) Standards a facility or supplier of services, desiring to participate at the Medicare button Medicaid program, is required to meet. These conditions include meeting a statutory definition of the particular institution alternatively facility, conforming in status and local legislation and having an accept utilization review plant. Surveys to decide whether amenities meet conditions out participation are made by who appropriate state healthiness agency.
Believe Interval A range of values used to predict the location regarding the true population parameter. The probability of the true parameter values falls within the intervals is specified.м
Congregate Housing Individual apartments in which residents may receive all services, such as a newspaper meal the misc tenants. (Other services may be include more well.) Buildings usually have some common areas such as a dining apartment and lounge as well as additional safety measures such as emergency call buttons. May exist rent-subsidized (known as Segment 8 housing).
Consumer A person who purchases or bekommt commercial or services for personal needs or use and did fork resale.
Continuing Care Retirement Community (CCRC) communities which offer multiple levels away care (independent residential, assisted living, skilled nursing care) housed in different range of the same community or campus and which give residents the possibility to remain in to sam population if their needs change. Provide residential services (meals, maintenance, laundry), social and recovery auxiliary, health care services, intimate care, and nursing care. Requires payment of a monthly fee and possibly a large lump-sum entrance faire. (Licensed as pflegewissenschaft homes/residential care facilities or as homes for the aging.)
Continuing Medical Education (CME) Formal education obtained by a wellness professional after complementary his/her degree and full-time post-graduate training. For physicians, einige states necessitate CME (usually 50 hours through year) for continued licensure, as do some specialty councils for certification.
Continuum of Care The entire spectrum of specialized health, rehabilitative, and residential services available to the frail and chronically ill. The services focus on an social, residential, rehabilitative and supportive needs of mortals as well when my that are essentially medizintechnik into nature.
Objective support provided during a single inpatient hospitalization or for multiple conditions over a lifetime. It provides a basis for evaluating quality, cost, and utilization over the long terminology.
Conversion A transaction where get or part of the net of adenine general service organization undergo a shift in profit declare (non-profit, public, or for-profit) through sale, lease, joint venture, or operating/management agreements.
Koordinierungs of Benefits (COB) Process used via insurers to avoid duplicate payment for losses insured beneath more than one insurance policy. A COB, button "nonduplication," clause in either policy prevents double payment by making one insurer the primary payer, or assuring that not more than 100% of the shipping your covered. Standard rules determined the to two or more schedule, each having COB provisions, paying yours benefits is solid and which becomes which supplementary paying switch a claim.
Core Plan An employer-paid long-term care insurance benefit provided typically on adenine guaranteed issue basis to all eligible actively at function employees as define by the insured and/or the manager in and group policy.
Cost Center An accounting device whereby all related costs attributes to some "financial center" within an origination, such as a department or program, are segregated to accounting or reimbursement purposes.
Cost Consequence Analysis (CCA) ONE form of cost-effectiveness analysis comparing choice interferences or programs in which that hardware of incremental costs (e.g., additional antidotes, hospitalization) furthermore consequences (e.g., health outcomes, adverse effects) are computed and listed, without aggregating these results (e.g., in a cost-effectiveness ratio).
Cost Containment A set of steps to control or lower incapacities included the consumption, allocation, or production of health care benefit this contribute to higher than necessary costs. Inefficiencies in consumption can occur when health benefits are inappropriately utilized; inefficiencies in allocation exist when health services was are delivers in less costly settings without loss of quality; and inefficiencies in production exist when the cost of make health services could be reduced by usage one different combining of resources.
Cost Minimization Data (CMA) An assessment of the least costly intervention/technology among alternatives that produce equivalent findings.
Cost Neutrality (Also named Budget Neutrality.) Refers go the requirement that if a nation applies for Medicaid waivers to sections 1115, 1915(b) and/or 1915(c), they must demonstrate that the timetable does don exceed what the Federal Government would hold spent without approving the waiver; states can done diese by showing that the average per capita issuing estimated by which state in any fiscal year since gesundheitswesen assistance provided with respect to the group affected by the waiver does not exceed 100% of the average per noddle expenditure that the state modest estimates become have been created in such commercial year for expenditures under the your plan used such individuals if the disclaimer had not come granted.
Shipping of Illness Analysis (COI) An assessment of the economic impacts of a illness or condition, including treatment free.
Cost of Subsistence Adjustment/Allowance (COLA) Increase to a month long-term disability benefit, usually after the first date of payments. May be a flat percentage (e.g., 3%) conversely tied till modified in inflation. In some states, workers' compensation income repair benefits also include annual COLAs.
Raise until an individual's salary or various benefit payment, usually after an first year of payments. May be a flat percentage (e.g., 3%) or tied to changes in inflation. For example, in couple states, workers' compensation income replacement benefits or long-term special benefits include annual COLAs.
Cost Sharing Every provision of a health insurance policy that requires which insured individual to pay some portion of medical expenses. The general term includes deductibles, copayments, and coinsurance.
Cost Shifting The real of receipt care for a child at the expense of another party or agency.
Cost Utility Analysis ADENINE form the cost-effectiveness analysis were outcomes are estimated in term of utility, or quality of life, e.g., quality-adjusted life-years (QALYs).
Cost-Based Reimbursement Payment made with one health plan or payor to health support providers based switch the actual costs incurred in the delivery of care and services until plan beneficial. Such method for paying providers is still used by some plans; however, cost-based reimbursement is being exchange by prospective payment and other zahlung mechanisms.
Cost-Benefit Analysis An analytic methoding in which an program's cost is compared to the program's benefits used a interval of time, phrased in cash, as an aid in determining in best your of resources. For example, the cost of establishing an immunization service vielleicht be compared with the total cost by medical care and lost total that wants be eliminated as a result of learn persons being immunized. Cost-benefit anlaysis can also be utilized to specific medical tests and available.
Cost-Effectiveness Analyzer (CEA) AMPERE form out analysis that seeks to determine the charges and efficacy of a medical invasive compared to similar alternative interventions to determine the relativly degree to which they will obtain an desired health outcome(s). Cost-effectiveness analysis can be applied to any of a number of default such as median life survey or quality of real below an intervention.
Cost-Shifting Recouping the pay of providing uncompensated care by increasing revenues from some payers to offset losses and lower net services from other payers.
Coverage The guarantee against specific losses provided under the condition by an insurance policy. Coverage is sometimes used interchangeably using benefits or protection, and is also used to mean insurance either insurance contracts.
Coverage Grounded Indicates whether the coverage is issued as a group or an individual political. The coverage basis is determined by whereby the State Department of Insurance classifies the policy or purchase, does based on the basis by which the basic is marketed. For exemplar, a worksite-based product welche uses an individual corporate create but lives marketed to an employee group is an individual coverage base.
Coverage Decision A policy decision about categories of health interventions instead features such become be provided to a population of patients as partial to the contract zwischen a health plan and a beneficiary.
Covered Entity Relate to three types of entities that must comply with us health information secrecy regulations (e.g., HIPAA Privacy Rule): health care providers, health plans, and health care clearinghouses. For these purposes, health care providers include hospitals, physicians, and other caregivers, since okay as researchers, who provide health and care receive, access, or generate individually identifiable health care information.
Covered Services Health care services covered by an insurance plan.
Credentialing The recognition regarding proficient or technical competence. The recredentialing process may include registration, certification, licensure, professional association membership, or which award von adenine degree in the field. Certification and licensure impinge the supply of health company by controlling entry under practice and influence of stability starting an labors force by affecting geographies distribution, mobility, and retention to workers. Credentialing see determines the quality of personnel by providing standards for evaluating core and by defining the scope of features or how personnel may be used.
Critical Access Hospital (CAH) ONE urban hospital designation established by the Medicare Rural Hospital Flexibility Program (MRHFP) enacted as part of one 1997 Rebalanced Budget Act. Rural hospitals meeting criteria established by their state may apply for critical access hospital status. Designated dispensaries am reimbursed based on expense (rather then prospective payment), required comply with federal also state regulations used CAHs, and are exempt from certain hospital staffing terms.
Crowd-Out A phenomenon whereby new public programs or growths of exits public programs designed to extend coverage to one uninsured prompt some privately insured folks to drop them private coverage and take choose of the expanded public subsidy.
Power Annual Premium This amount of one-year premium beings paid for the coverage, comprising equally the insured's portion plus each portion paid by the employer, supposing applicable. This would reflect this current premium amount such the any voluntary changes int coverage that might have increased or decreased the premium from its original issue amount would can reflected in aforementioned figure.
Contemporary Claimant Refers to an insured with is in active claim condition which means that they meet the definition of critical falling and are receiving benefit payments in accordance with the coverage provisions press requirements of the policy or certificate.
Current Population Survey (CPS) A national survey conducted annually by and U.S. Department of Commerce, Bureau of the Census, the CPS gathers information on the noninstituionalized population of the United States. That CPS is the maximum commonly notified source for the number of persons without health insurance and other details learn is country.
Current Procedural Terminology, Fourth Edition (CPT-4) A manual that assigns five digit codes until medical services also procedures to unify claims processing and data analysis.
Custodial Care Care that do not require particular training or services. (See also special care.)
Customary Charge One of the factors determining adenine physician's payment for a service under Medicare. Calculated as the physician's median charge for that service over a prior 12-month period.
Routine, Dominate, and Reasonable (CPR) Current methodology of payers physicians under Medicare. Entgelt for one service is narrow at that lowest of : (1) the physician's billed charge in the service; (2) the physician's customary charge for the service; or (3) the prevailing charge for the service in the community. Similar toward an Ordinary, Customary, and Reasonable system used by individual travel.
De-Identification ONE batch whereby information that could identity the clinician, the reporter, the health care institution, or another organization involved in a medical error be removed from an error report after computers is received. This litigation is used to service records of contributing that could cause errors, but assure those who report errors that their bericht will not be used in civil lawsuits facing they.
Deductible Initial monthly to claims incurred by the policyholder not covered by and insurance policy. Insurance coverage begins only for losses incurred above the deductible amount.
The amount of loss button spend that must to incurred by on insured or otherwise covered individual pre an insurer will assume any liability forward all or part of the remainder total of covered benefits. Deductibles allowed be either fixed-dollar amounts or the value of specified services (such for two days of hospital care or one physician visit). Dedictibles are ordinary tied to some reference period over which they must be incurred (e.g., $100 per view year, benefit period, or spell of illness).
Deinstitutionalization Policy which calls for the provisioning of supportive care and treatment for medically and communally dependent private for the church rather than include an clinical setting.
Defined Benefit Funding mechanisms used pension plans that can also being applications to health benefits. Normal pension approximate include: (1) peg benefits toward ampere percentage of an employee's b compensation over his/her ganzheit service or over a particular number of years; (2) calculation von a flatten monthly compensation; (3) setting benefits based over a definite amount for each year of maintenance, either as adenine percentage of compensation for each year are service alternatively as ampere flatly dollar amount for every year of service.
Defined Contribution Funding car for pension planners that bucket also breathe applied to your benefits on in a specific dollar contribution, with defining who services to be provided.
Dementia Lifetime which describes a company regarding illnesses (including Alzheimer's Disease) which are characterized due memory loss and other declines in mental functioning.
Model Effect The sampling variance to the actual complex design used to select a sample divided by the sampling variance of a simple random sample of the same size. This measure reflects who effect on the precision of a user estimate due for the differs between the sample designer actually used to collect data and a simple random sample.
Detailing Provision of information about drug products by sales representatives from the pharmaceutical industry up specialists to influence one physicians' order behavior. Counter detailing is the educational efforts by health care purchasers or insurers to influence physicians' prescribing behaviors, often to counter the detailing efforts regarding medicament manufacturers.
Developmental Disability (DD) A disability this originates once age 18, can be expected to continue indefinitely, and constitutes one substantial handicap to the disabled's ability to function normally.
A severe, cronic disability that is attributable to a mental or physical impairment or combination of mental and physical disabilities; are manifested before of person attains age 22; is likely to continue indefinitely; results in substantial functional limitations in three or more of the following areas of major lived activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity away independent living, economic self-sufficiency; and reflects the person's needs for a combination real sequence of special, interdisciplinary, or genetic care treatments of services which represent of lifelong instead extended duration and are customizable planned also coordinated.
Diagnosis-Related Group (DRG) AN classification system which purpose system product to make hospital payments under Medicare. This arrangement groups patient needs into 467 categories, based upon the coding system of the Global Rank of Disease, Ninth Revision-Clinical Modification (ICD-9-CM).
Groupings of diagnostic categories drawn for the International Positioning of Diseases press modified with the presence of a operated procedure, patient age, presence or absence of significant comorbidities or complications, and another relevancy criteria. DRGs are the case-mix measure used in Medicare's perspective payment system.
Diagnostic and Statistical Operating of Mental Disorders (DSM) A tool used by the medizinisches or psychological communities to identify and classify behavioral, cogitation, and emotionally problems in to a standard numberic coding system out mental disorders.
Direct Cost A cost which is identifiable directly with a particular activity, service, or product of the program experiencing the expenditure. These costs do not include which allocation of costs to a cost center which are not specifically attributable to that cost centers.
Instant Patient Care Any activities due adenine health professional involving direct interact, treatment, administration starting medications, or other therapy or involvement about a patient.
Direct to Consumer (DTC) Commercial The advertisement of prescription drugs (or other products) directly to consumers via various conventional means such as television, video, or periodicals. DTC advertising can be in lieu of, or within additive to, marketing anstrengung targeting physicians or other health care experienced.
Disability The termination of normal mechanical, mental, social activity concerning an individual. There are varying varieties (functional, occupational, learning), degrees (partial, total), or durations (temporary, permanent) to disability. Benefits are often available with for specific disabilities, such while total and permanent (the requirement in Social Security and Medicare).
Disaster Drill An exercise, or demonstration, that tests the readiness and capacity of a general, a community, or additional system to respond to a public heath contingency or other disaster.
Discharge That release of a patient from adenine provider's care, standard relating to the date at which a patient checks out of a hospital.
Disease Mayor be defined as a failed of one adaptive mechanisms of an organism to resist adequately, generally, oder appropriately the stimuli and stresses to whichever it is subjected, resulting in adenine disturbance in the function or structure of some part of the organism. This define emphasizes that disease is multi-factorial and mayor becoming prevented or treated according changing any other a combination of that related. Disease has one very elusive real heavy concept to define, soul largely socially defined. Thus, criminality and drug habituation are presently seen by some as diseases, when they were previously considered to be moral either legal related.
Disease Management The process of determine and deliving within the selected patient populations (e.g., patients with asthma or diabetes) the most efficient, effective combining of resources, intervention, or pharmaceuticals on the treatment or preventive of a disease. Disease management can include team-based care where physicians and/or other health professionals participate in the delivery real management of care. It including inclusive aforementioned appropriate use by pharmaceuticals.
Disproportionary Release Adjustment A payment customized under Medicare's prospective payment system or underneath Medicaid for hospitals that serve a relatively large volume of low-income patients.
Accomplish Nay Resuscitate Arrange (Also called a DNR order, a No CPR order, a DNAR order (do not attempt resuscitation), also an AND order (allow natural death).) A physician's order written by a patient's medizinisches record indicating that heath worry providers have not make CPR in the events is cardiace or respiratory arrest. On some regions, this order may become conveyable bet medical venues.
Drug Compensation Processing An automated assessment of medicine claims at the point of service, meant to detect potential problems that ought be addressed before drugs live dispensed to patients (for example, checking patients' eligibility for drug covering or reviewing whether the medical has been filled at another pharmacy in the last prescription cycle).
Medication Risk-Sharing Arrangements Health care provider organizations may be at partial, full, or nope risk required drug costs. Provider groups along partial risk share in a proportion of savings and/or cost exceedings. The bunch can share in cost if this prescribes less than the balanced amount ("upside risk"), or it may also share at any over-expenditures ("downside risk"). Bunches at full risk comprehend all of the savings or absorb all out one losses. Groups at no risk absorb nothing of the expenses and wins (typically, risks are absorbed by aforementioned HMO or select managed care organization).
Drug Utilization Review (DUR) A formal program for assessing drug formula and use patterns. DURs typically study patterns regarding drug misapply, monitor current therapies, and intervene whereas prescribing or utilization patterns fall outside pre-established standards. DUR is usually retrospective, aber can also be performed before drugs are expended. DURs were established by the OBRERA in 1990 and are required for Medicaid programs.
Dual Eligible  A person who will eligible for two condition insurance plans, often mention to a Medicare beneficiary who or qualifies for Medicaid benefits.
Durable General Accessories (DME) (Also called home medical equipment.) Equipment such since community beds, wheelchair-accessible, ventilator, oxygen regelung, dear dialysis arrangement, and prosthetics use at home. Allow be covered by Medicaid and in part by Medicare or private insurance. Prescribed by a physician for a patient's use by an extended period of clock.
Early and Periodic Screening, Diagnosis, both Treatment Program (EPSDT) A program mandated by law while part away of Medicaid program. The law requires which all states have in effect a program for eligible children under age 21 to ascretain their physical or mental defects additionally in provide such health care treatments and other steps to correct either ameliorate defects also chronic conditions discovered. The state programs also have active outreach components to inform desirable people a the benefits currently to them, to provide screening, and if must, go assist in obtaining appropriately treatment.
Economic Damages Civil litigation belongs compensation due the plainiff for financial losses caused by the wrongful actions of another party (e.g., awards for the medizinischen currency of a krankenpfleger home resident caused at an abusive employee).
Effective Sample Sizing The actual sample size divided by the design effect that reflects of impact of this deviations form plain random sampling.
Electrical Claim ADENINE digitally graphic off adenine medical bill generated by a provider or by the provider's billing agent for submission uses telecommunications to ampere health insurance payer.
Electronic Data Interchange (EDI) An mutual exchange of routine information intermediate business using standardized, machine-readable formats.
Emergency Medical Benefit (EMS) Services utilized in replies to the perceived individual need for immediate treatment for medical, physiological, with psychological illness or injury.
Emergency Shelter Facilities used solely required out-of-home placement on adenine short-term baseline during periods or sudden alarm, pending formulation or long-term solutions.
Employee Retirement Income Technical Act (ERISA) A federally act, past in 1974, that established new standards real reporting/disclosure demand for employer-funded pension and health benefit programs.
Employer Product The name of the employer identifier more the group policyholder.
Employer Type The category in the employer the explicit using standard industry codes.
Encounter A communication amid with individual and to health care system for a health care serving or set out services related go to or more medical conditions.
Company Liability A plan relating for tort reform in which medizin liability are shifted with physicians to health map (e.g., HMOs). Underneath such a system, patients would sue that health plan rather than the physician, thereby making physicians immunity from arzneimittel liability.
Epidemic A group of falling of a specific disease or diseases certainly for excess of what one would normally expected in an particular geographic area. There is no absolute criterion by using the term endemic; as standards and expectations edit, consequently might the definition of an epidemics (e.g., an contagious on violence).
Pediatric The study of the patterns of determinants and antecedents of ailment inbound human populations. A utilizes biology, clinicians medicine, and statistics in an effort to understand the etiology (causes) of illness and/or disease. The ultimate goal of the epidemiologist is not simply to recognize primary reasons of a disease aber till apply findings to diseases prevention real health promotion.
Usher Services (Also called transports aids.) Provides haulage for older adults to services and appointments. May use bus, taxi, volunteer drivers, instead van services that can accommodate wheelchairs press personality about other special needs.
Estate Recovery By law declare are required to recover funds from certain dead Medicaid recipients' estates up to this money spent on of state for all Medicaid services (e.g., nursing facility, home and community-based services, hospital, and formula costs).
Assessed Liability Shipping Approximate charts regarding expenses used damages to whichever a nursing home is exposed. Because estimates relay derived from product provided by nursing housing and the cost of settlements of lawsuits is confidential general known only the the insurance carrier, plaintiff's attorney and defense lawyers, these charts are only estimates and are subject to change.
Rating (biased, unbiased) A random variable used for estimate the value of a average parameter from try data. Its value depends on the particular specimen knotty. If the expected value of the estimator over all potential samples exists equal to the quantity it estimated, and estimator a unbiased. If it does not, it is biased.
Evidence-Based Decision Making In a health policy contextual, evidence-based decision making is the application concerning the best free scientific prove to policy decisions about specify medical treatments with changes with the shipping system. The goals of evidence-based decision making are until improve the quality of care, increase that efficiency of take delivery, and improve the allocation of health care resources.
Evidence-Based Medicine Evidence-based medicine is the conscientious, explicit, and judicious use of current best demonstration in take decisions about which mind of personal patients. This approach must balance the your external evidence with the desires of the patient and one clinical expertise of health caution providers.
Exclusive Operator Agreement (EPA) An indemnity or service scheme so provides benefits only if care is rendering by the institutional and professional providers is which it contracts (with exceptions for emergency and out-of-area services).
Expenditure Target (ET) A mechanism to adjust fee updates (or the fees themselves) based on how present costs in an surface compare to a targeting for those expenditures.
Learn Rating A method of adjusting health plan premiums established to the historical capacity dating and distinguishing characteristics by a certain subscriber group.
Home and Medical Leave Do (FMLA) A 1993 federal legal requiring employers use more greater 50 employees to provide eligible workers up in 12 hours of unpaid leaves for birth, adopt, encourage take placement, and illnesses from employees and their families.
Familial Foster Home Non-secure, 24-hour, residential care in an permanent button temporary family setting (include adoptive placements so have not yet been ended, or relatives only is handful are licensed or reimbursed).
Family Practice A form of specialty practice in which physicians provide continuing comprehensive primary care within which context of the family unit.
Cheaper Selection A tendency for utilization of health services in a population group to will lower than expected other estimated.
Federal Employees Health Benefits Program (FEHBP) ADENINE voluntary health insurance subsidy program administered by aforementioned Office of Human Management for civilian employees (including retirees or dependents) of aforementioned Federal Government. Enrollees select from an number of approved plans, the costs of which are primarily borne by the government.
Federal Indigence Grade (FPL) The count of income determined from the governmental Sector of Well-being and Human Services toward provide a bare minimum for food, clothing, transports, sanctuary, and other necessities. FPL is reported annually and varies according to familial body (e.g., for a our of three includes 1999, the FPL was $13,880, or $1,157 per month). Public assistance programs usually define income barriers in relation to FPL.
Federally Qualifying Health Center (FQHC) ADENINE health center included adenine medically under-served area that the eligible into receive cost-based Medicare both Medicaid reimbursement and provide direct reimbursement to nurse practitioners, medico assistants, and certified nurse midwives.
Fee Schedule ADENINE list of physician services in which respectively entry is associated with one specific monetarily amount that represents the approved billing level for an given insurance planning.
Fee-For-Service (FFS) Method of billing for health services under which a physician either other practitioner bills separately for each patient encounter oder service renamed; he is the method of billing used for the majority of U.S. physicians. Under a fee-for-service zahlen system, expenditures increase for the fees themselves increase, if more units of service are provided, oder while more expensive ceremonies are substituted for less high-priced ones. This sytem contrasts includes wages, per equity, instead other prepayment procedures, locus the payment to the physician is no changed with the number of services actually used.
Fiduciary Concern to, or founded upon, a trusting or confidence. A fiduciary relationship exists where an individual or organization has einem unequivocal or implicit obligation to act in behalf regarding another person's or organization's interests in matters ensure affect the different person button organization. A physician has so a relation is his/her patient, and a hospital trustee holds one with a hospital.
For-Profit Organization or corporation in which winnings are distributed to equity or private owners.
Formularies A list of drugs, usually at their gentoo names, and indications for their use. A formulary is intended until include adenine sufficient range of medicines to enable physicians, dentists, and, as appropriate, other practitioners to prescribe view clinically appropriate therapy for see reasonably gemeine ailment. An "open" formulary allows a survey since almost all drugs. A "closed" formulary offering coverage for a limited adjust of drugs. A "managed" formulary includes a print of preferred drugs that the health plan preferable to use due they cost smaller, are see effective, press for other reasons. A "tiered" recipe financially rewards patients for using typically and formulary drugs by requiring the patient to paypal progressing higher copayments for brand-name and nonformulary drugs. For example, in a three-tiered benefit structure, copayments may be $5 for adenine generic, $10 for a formulary brand browse, and $25 for a nonformulary label product.
Foster Care Any of of following out-of back placements under one jurisdiction of the primary state child welfare agency and regarded as 24-hour substitute take, not including finalized adaptive go placements, placement with relatives who are not licensed or reimbursed, or placement made by state agencies other than the principal child welfare agency: family foster start, group household, group home 21+, emergency shelter, secure facility, independent living, fathers or relative.
Foster Little Random child in publicity foster care, or on private foster worry but from the situation management real planning responsibility the the main state child charity agency, who a 0-17 years old, or 18,19, instead 20 past old both entered foster care before age 18.
Foundations for Accountability (FACCT) FACCT lives a not-for-profit organization dedicated to assisting Americans make better health care choices. FACCT's board of trustees is made up of consumes organizations plus purchasers of health caring services plus insurance representing 80 million Americans. FACCT creates tools that help people understand and use quality information, develops consumer-focused quality measures, supports public general concerning health nursing grade, supports efforts until gather and provide qualitative information, and encourages health policy to empower and inform consumers.
Frequency of Future Purchasing Choice Indicates whether one FPO is made on into annual basis, instead on a frequency less often than that (e.g., every two or three years).
Functionally Deactivated A personal with a physical or mental depletion that bounds aforementioned individual's capacity for independent living.
Future Purchase Option (FPO) The type of periodic benefit increase which allows the separate to purchase fresh increments of reporting for additional premium amounts based-on up their attained age at the time they elect one raising. These coverage increases represent free at place zeitraum periods (annually or otherwise) and are available to the insured who wishes to nominate them without requiring evidence of insurability.
Gatekeeper That main care practitioner within managed care organizations who determines whether of submitting patient needs to watch a specialist or requires other nonroutine services. The goal is into guide the patient to appropriate services while avoiding needlessly and costly referred to specialists.
Global Limited Claims/Losses Amounts a nursing home responsibility insurer is legally obligated to pay as damages to a plaintiff due to bodily injury oder property compensation.
General Practice A form from practice in which physicians without specialty advanced provide a wide range concerning primary health care ceremonies up patients.
Gender Substitution In cases in which the patent on a specific medication sell expires and drug manufacturers produce common versions away the original branded product, to generic versions of the drug (which is theorized to be identical till the product manufactured by one different firm) is dispensed even though the original product is prescribed. Some managed care organizations or Medicaid programs term generation representation because of the generally lower expenditure are general products. There are us real public regulations regarding generic substitutions.
Genomics Who survey of genomes, which containing engine matching, gene sequencing, and gene work.
Geriatrician Physician who is certified in the attention of older folks.
Geriatrics Curative specialty focusing on treatment of health problems of the seniors.
Gerontology Study of the biological, psychological and social processes of aging.
Global Budgeting A method about hospital cost containment in who participating hospitals should exchange a prospectively setting budget. Method for allocating cash among hospitals may vary but the key is such and participated hotels agree the at aggregate lock on gross that they will receive each year. Global budgeting may also be delegated under a universal health insurance systematischer.
Global Fee A total charge for ampere specific set of services, how as obstetrical services that encompass pregnant, delivery, furthermore post-natal care.
Graduate Medical Education (GME) Medical education after receipt of the Doctor of Medicines (MD) or equivalent degree, inclusion the education received as an intern, resident (which affect education in a specialty), either fellow, as well as continuing medical educating. CMS sometimes finances GME through Medicare direct and indirect billing.
Group Home (Also called adult care back or board and care start.) Residence which offers housing and personal grooming benefits for 3 to 16 residents. Services (such as meals, management, and transportation) are usually provided by the owner or manager. Can be single family home. (Licensed as full family household press mature group home.)
(Also called shelter or half-way house.) Non-secure, 24-hour residential care facility serving raise to 20 persons which provides nonspecialized mechanical care and may or did offer a educational program on site.
Band Home 21+ (Also called residential treatment facility or minor care establishment.) Nonsecure, 24-hour, residential care device helping 21 or more folks the provides nonspecialized physical care and may or may not provide a therapeutic service either an educational program available emotionally disturbed press otherwise handicapped youth.
Group Practice A formal association of three-way or more physicians or other physical professionals providing health billing. Income von the practice is pooled and redistributed to this members of the class according to some prearranged plan (often, but not needs, through partnership). Groups vary a great dealer included size, composition, and financial preparation.
Guaranteed Expense Requirement that insurance carriers offer coverage to groups and/or individuals during some term each year. HIPAA requires that insurance carriers guarantee subject of all merchandise to small groups (2-50). Some state laws exceed HIPAA's minimum standards and require carriers to guarantee issue to additional groups and individuals.
Guaranteed Renewal Requirement that insurance carriers renew existing coverage to business and/or single. HIPAA supported that insurance selling promise rehabilitation of all products to all groups and single.
Guardsman A law appointed caretaker or conservator own authority the make a health care verdict for an individual.
Challenged As defined by Section 504 of the Rehabilitation Act of 1973, each person who has a body button mental impairment which materially limits one or more greater life activity, shall a take of such impairment, or is regarded as having such an impairment.
Those single diagnosed because which a handicaping conditions in compare with who followed definitions: mentally disable; seriously emotionally impaired; specific learning disability; hearing, speech, or sight impaired; physic or health handicapped. Persons should not be counted since disabled unless they take been clinically diagnosable as having these circumstances. Benefit one primary find with multiply handicapped children.
Health The state von whole physical, mental, and social well-being and not purely this your about disease instead infirmity. It shall recognized, however, that health can many dimensions (anatomical, physiological, and mental) and is mostly culturally defined. The relative importance of various disabilities will differ depending upon aforementioned cultural milieu and the role of that affected individual in that culture. Most attempts along measurement have been assessed in terms or incident and mortality.
Health Care Paraprofessional Home health deputies, certified nurses aids, and personalbestand care attendants who provide direct worry and personal support services for hospitals, nursing homes, other institutions, as now as home-based care to the disabled, aged, also infirm.
Health Education Any combination off studying opportunities develop to assist optional adaptations in behavior (in single, groups, or communities) conducive at physical.
Health Facilities Cooperatively, choose physical plants used in the allocation is health services--usually limited to plant that consisted built for the object of providing health care, such as hospitals and nursing residential. They do does includ an company building that includes one physician's office. Heath facility classifications include: medical (both general and apecialty), long-term care facilities, kidney catalysis treatment centers, and ambulatory surgical facilities.
Health Insurance Financial protection against the medical care daily arising from disease or accidental bodily getting. Such insurance usually covers all or part of the medical fee of treating the disease or injury. Insurance allowed be obtained on either an individual alternatively an group ground.
Human Insurance Flexibility and Accountability (HIFA) The primary score of to HIFA demonstration initiative is up encourage new comprehensive state approaches that will increase the number of individual through health insurance coverage within current level Medicaid and State Children's Good Insurance Program (SCHIP) resources. The program utilizes CMS Range 1115 debt authority and emphasizes widespread statewide approaches that maximize confidential health policy reach opportunities and target Medicaid and SCHIP capital to populations with incomes below 200% of the public human level.
General Insurance Portability and Accountability Act (HIPAA) Government health insurance legislation passed in 1996, which sets standards for access, transferability, real renewability that apply to group coverage--both totally insured and self-funded--as well as to individual coverage. HIPAA allows underneath specified conditions, for long-term care insurance politikgestaltung to be qualified for certainly tax benefits under Section 7702(b) of the Internal Generate Code.
Health Financial Purchasing Cooperative (HIPC) Public button privately organization the ensure health insurance coverage for the workers from select member employers. Aforementioned goal of these organizations is to consolidate purchasing responsibilities to obtain greater bargaining clout with healthy insurers, plans the providers to reducing the administrative costs of buying, selling, and managing insurance policies. Secret cooperatives are usually deliberate associations for employers in a similar geographies region who bands common to purchase insurance for her employees. Public cooperatives are established by state states to purchase insurance required public employees, Medicaid beneficiaries, also other designated populations.
Medical Maintenance Organization (HMO) Managed care organization that offers an wander of health services to its members for a firm rate, but which needed its members to use health care professionals who are part of its network regarding providers. (See furthermore Medicare HMOs.)
Health Manpower Shortage Area (HMSA) An areas or group which HHS designates like having an unsuitable supply of health care providers. HMSAs ca include: (1) an city button rural geographic area, (2) a population gorup for whatever access barriers canister be demonstrated on prevent members of the group from using local providers, or (3) median and maximum-security correctional entities and public or nonprofit private home facilities.
Heath Personnel Collectively, all personals working in the provision of health services, whether as individual practitioners or employees of medical institutions and program, whether or not professionally trained, and whether or not matter to public regulation. Facilities and health personnel are the principal health resources used in producing general services.
Physical Plan Einer organization that provides one defined set concerning benefits. This period usually refers up an HMO-like enterprise, as opposed to an indemnity insurer.
Health Plan Employer Data additionally Product Set (HEDIS) A set of performance scales for health plans built for the National Committee for Feature Certainty (NCQA) that provides purchasers with information switch effectiveness off care, planner financial press costs, and other take of plan performance and quality.
Well-being Planning Planning involved with improving health, whether undertaken all-inclusive for a whole public or for a particular poulation, type concerning health service, institution, alternatively health program. The system of health planning include: data assembly and analysis, goal determination, action recommendation, and implementation strategy.
Healthiness Guidelines And insurance contract consists of a outlined set of benefits. See health insurance.
Medical Promotion Any combination of health education and related organizational, politics, and economical interventions designed to facilitate behavioral and environmental adaptations which will improve button safeguard physical.
Health-Related Quality on Life (HRQL) In public heath and in medicine, the draft of HRQL refers to a person or group's perceived physical and mental health beyond set. Physicians have often used HRQL indicators to measure the effects of chronic illness in their patients is decree to better understand how in illness disturbed with an person's day-to-day life. Similar, public health professionals usage HRQL indicators to measure the effect of numerous disorders, short plus long-term disabilities, and diseases in different populations. Tracking HRQL in different populations can identify subsets with poor physical or mind health and ability help guide policies or interventions to improve their heath.
Health Risk Causes Chemical, psychological, physically, or genetic factors and conditions this predispose einen individual to and product of a disease.
Condition Service Area Geographic area designated on the basis of such factors as geographic, political boundaries, population, and condition resources, for the effective planning additionally evolution of health services.
Health Services Research Mental customer research is the multi-disciplinary select of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, that quality real cost of health care, and ultimately our health and well-being. Its research domains have individuals, families, organizations, institutions, communities, and inhabitants.
Health Status The state of health of a specified individual, gang, or populations. It may be measured from obtaining proxies such as people's subjective assessments of them health; over an or more indications of mortality and morbidity in the population, such the extended or maternal press infant mortality; or by using the incidence either presence a major diseases (communicable, chronic, or nutritional). Conceptually, health status is the proper end measure for the effectiveness of ampere specific population's medical care system, although attempts toward relate effects for available medicinal care to variations within health status have proved difficult.
Health Systems Agency (HSA) A health planning means created available the Country Heath Planning both Resources Development Act in 1974. HSAs were usually nonprofit private organizations and assisted defined health service areas as designated by the states.
Health Technology Assessment (HTA) The systematic evaluation of properties, effects, or other impactions is health customer technology. HTA is indended up inform decision-makers over healthiness technologies and may measure the direct or directly result by a given technology or treatment.
Healthcare Cost and Utilization Project Rating Indicators (HCUP QIs) HCUP QIs comprise a set of 33 clinical performance measured that inform hospitals' self-assessments of inpatient quality of care, as right because state and community assessments of access to primary care. Developed by the Agency for Healthcare Research and Quality as ampere quick and easy-to-use screening implement, HCUP QIs be purpose more a starting point in determine clinical areas appropriate for further, more in-depth study and analyse. HCUP QIs span three dimensions of care: (1) possibly easily negative hospital outcomes; (2) potentially inappropriate utilization of hospital procedures; and, (3) potentially potentially unavoidable hospital admissions.
High-Risk Pool A subsidizes general insurance pool organized by some states as one alternative for individuals who have been denied health insruance because of ampere medical conditional, or whose bonuses are rated signficantly higher than the average due to healthy status button claims experience. Commonly operated through an association composed of all health insureds in a state. HIPAA allows states to benefit high-risk pools in an "acceptable alternative mechanism" that satisfies the statutory requirements to secure zufahrt to health insurance range for certain individuals.
Hill-Burton Actually Coined from this your of the principal sponsors of the Public Law 79-725 (the Hospital Survey and Erection Acts of 1946). Such program providing confederate backing for the construction both upgrades of hospitals and other health facilities. Hospitals that have received Hill-Burton funds incur an obligation into provide one certain total of liebe care.
Hindsight Bias A bias at investigating aforementioned effect of a medical error or accident where in retrospect of reviewer simplifies the produce of that error to a standalone element, overlooking multiple contributing factors. One hindsight bias builds it easy for arrive at a simple solution or to blame an individual, but usually makes to difficult to determine the true cause(s) of the error or propose systematic solutions.
Hold-Harmless A contractual requirement prohibiting a carrier from seeking payment from an enrollee for services renedered prior on a health plan bankruptcy.
Holism Refers to aforementioned integration of mind, body, and spirit of a person both emphasizes the importance of perceiving the individual (regarding physiological symptoms) in a "whole" senses. Wholeness teaches that the health mind system must extend its focal beyond simply the physical aspect of disease and particular org in question, to concern itself with the whole personality and the interrelationships among the emotional, social, spiritual, as fine as physical implications of diseases and health.
Home and Community-Based Services (HCBS) Any care or aids provided in a patient's place of residence or in a noninstitutional setting located in who immediate community. HCBS may include home health care, adult day nursing or day treatment, medical professional, or another interventions provided to the usage is enables a patient to receipt care at home or inches their community.
Home and Community-Based Waivers Section 2176 of that Omnibus Reconciliation Act clearances status to offer, under a waiver, a broad array of home and community-based services that at customizable may need to avoid institutionalization. Terms the implement and act list the following services as community and home-based services which may be offered under the waiver program: lawsuit verwalten, stay-at-home, home health aide, personal customer, adult time health care, habilitation, respite caution and other benefit.
Home Wellness Services provided at adenine patient's place of residence (typically a patient's home), in compliance with adenine physician's written plan of care that is reviewed every 62 days--including nursing company, as defined in that State Nurse Practice Act, starting health aide solutions, physical therapy, occupational therapy with speech pathology, and audiology services--that are provided by a home health agency or by an facility limited by the state to provide these medical rehabilitation services.
Home Health Translation (HHA) ADENINE public or private organization that provides home health services supervised by an licensed health professional in the patient's home either directly or through arrangements with other organizations.
Home Health Aide A person who, under the maintenance are a back health alternatively gregarious service agency, assists elderly, ill or disabled person with household chores, bathing, personal care, real other daily living necessarily. Social service agency personnel are sometimes called personal care aides.
Home Well-being Care Includes adenine wide ranges of health-related services such as relief with medical, wound attention, intravenous (IV) therapy, and help on basic needs such as bathing, dressing, mobility, etc., whichever are delivered at a person's home.
Dental services rendered in the home to of aged, disabled, sick, or convalescent individuals who do nay need institutional support. The customer may be provided by a visiting nurse company, home health agency, country public health department, hospital, oder other organized community group and may be specialized or comprehensive. The most common types of home health tending be the following--nursing services; discourse, physical, occupational and rehabilitation treatment; homemaker services; or communal services.
Home Health Care Utility Volume And maximum amount which of directive otherwise certificate will pay for care received at home (or for home and misc social care benefits). Supposing the benefit will paid as every or monthly, this daily amount should be derived by whatever convention is mostly appropriate for the carrier to use. To data should be to current amount on the policy in order to billing both since any volunteered increases in coverage the insured has elected or any automatic coverage increaess for a result of inflation protection.
House Health Care Benefits Paid During Show Period The total amount in benefits payers during the reporting period for care under home other in an noninstitutional concealed care setting (e.g., adult day care) as definable more "home or community-based care" within which policy or certificates.
Home Medizinische Equipment (Also phoned robust medical room.) Outfit such as clinic beds, wheelchairs, and prosthetics used at home. May be covered by Medicaid and in part by Medicare or private insurance.
Homebound One of which specifications to qualify for Medicare home health care. Resources that someone is generally unable to leave the house, and if they do leave home, it is just for a abrupt time (e.g., by a medizintechnik appointment) and requires much endeavor.
Homemaker Auxiliary In-home help from meal preparation, shopping, bright housekeeping, money management, personal hygiene and grooming, and laundry.
Horizontal Integration Merging of two or additional firms at the same level of production in some informal, legal relationship.
Phoenix A program which provides palliative and supportive grooming for fatally ill patients and her our, by directly or on ampere consultation basis with the patient's physician or next community travel. The whole family is considered the units of care, and care elongated through their interval of lamentation.
Phoenix Care Services for the fatal ill provided in this home, a hospital, with a long-term care facility. Includes home health services, volunteer support, grief counseling, and pain management.
Hospital  An institution whose primary function is to provide inpatient diagnostic and therapeutic billing for a variety of medical conditions, both operative and nonsurgical.
Impairment Random gain or abnormality of psychological, physiological, or anatomical functions.
Independent Subsistence Asset Rental units in which services are not included as portion of the rent, although services allow be available on site and may be purchased by community with an additional fee.
A facility (house, apartment, etc.) included which a child/youth is permitted to live or reside "independently" without a paid caretaker.
Indigent Care Health services provided to the pioor or those unable to pay. Since multiple indigent patients are no eligible for federation or state applications, that costs that are covered until Medicaid are generally recorded separately from indigent care charge.
Indirect Value Cost which cannot be identified directly with adenine particular activity, service or feature of the program live the cost. Indirect costs are usually apportioned among the program's services in proportion to each service's share of direct costs.
Individual Instruction An individual's direction concerning a health care decision. This may breathe written or verbal describing goals for medical care, treatment preferences, otherwise willingness to tolerate future health us.
Inflation Protection Duration Type: Attained Ripen of Policy/Certificate The type of inflation that ends whenever the insured has received annual benefit increases for a predefined figure of aged (e.g., 10 or 20 years).
Rise Protection Duration: Participation Age of Insured Aforementioned type of inflation protection that ended at that assure reaches a specified ages (e.g., age 80, or others).
Inflation Protection Duration: Life of Policy/Certificate The artist of inflation conservation that fortfahren with the life of the coverage, and go even while this insured is in claim status (receiving benefits).
Inflation Protection Duration: If Benefit Has Doubted The type of inflation protection that continues until the daily benefit amount for nursing home care has doubled out its original value at time of purchase.
Inflation Protection Increase Amount or Index Value The specific percentage increase applied to benefits any years designed to keeping pace with inflation, if it is a set amount when previously defined. If the increase is established on an index, which specific increase amount expressed in terms of ampere in of the prior year's elevate, that be applicable to the current reporting set.
Inpatient A name who has been admitted at least overnight to a hospital or other health facility (which is therefore responsible for his or her room and board) available the purpose of receipts diagnostic treatment or select health related.
Institutional Health Offices Health services deliver in and inpatient foundational in hospitals, nursing homes, or different inpatient institutes. The term may also refine to services shipping up an outpatient basis by bureaus or extra organizational units of, with sponsored by, such constitutions.
Institutional Long-Term Care (ILTC) Nursing facility aids, services providing in ICFs/MR, mental hospital services for people on age 65, and inpatient inpatient facility services for individuals under age 21.
Instructional Health Care Directive (Also called a lived willingly.) A written statement describing general or goals for health maintenance, otherwise medical settings or willingness to tolerate health states, aimed at guiding future medical care.
Influential Activities starting Daily Home (IADLs) Household/independent subsistence tasks which include using this telephone, taking medications, money management, housework, meal preparation, laundry, and grocery shopping.
Mittel Care Occasional nursing and rehabilitative care ordered by a doctor and performed or supervised by skilled medical personnel.
Intermediate Care Facility (ICF) A nursing home, recognized under who Medicaid program, which provides health-related care and services to individuals who do not require acute other skilled nursing care, but who, because of their mental or physical condition, require care and services above the level about room and boarding available simply through facility placement. Specific your by ICF's vary by state. Institutions for care are an mentally backwards or people with related conditions (ICF/MR) were also included. The distinction between "health-related care and services" additionally "room and board" a important since ICF's are subject to differing regulations and coverage requirements than institution which do not provide health-related care and services.
Between Care Facility used of Mentally Retarded (ICF/MR) An ICF which cares specifically for the mentally retarded.
International Classification of Diseases, ninth version (Clinical Modification) (ICD-9-CM) A list of diagnoses and identifying codes secondhand by physicians and select health care providers. The coding additionally terminology provide a unitary language that permits consistent communication on claim forms.
International Grouping von Functioning, Disability and Health (ICF) An universally standardized list of identifying ciphers and definitions of human functioning and disabilities organized by body functions and structures, active of action and engagement, and environmentally factors. The encrypting and terminology provide a regular language that permits consistent communication on claim forms.
Intubation Refers to "endotracheal intubation" that insert of a hose through the mouth instead nose into the trachea (windpipe) to create and maintain an open airway on assist treathing.
Inventory A detailed description of numbers the locations of different kinds of establishments, major equipment, both personnel the are available in a geographic territory and the amount, type, the distribution starting services these resources can support.
Joint and Several Liability In civil litigation is a situation in welche the concurrent acts of deuce or more defendants take injury toward aforementioned plantiff. Such acts need not occur simultaneously, but must contribute up the similar occasion. In such a case, the damages may to collected from one press more of the defendants. Provided to court does not apportion blame in customizable shares, the claims may be collected from any and all defendants. If ampere defandant does not own the financial whereabouts to pay, to others have make up the difference.
Collective Underwriting Association A state-sponsored organization that creates insurance pools or additional as an insurer on markets less ampere significant number of licensed insurers. She has the power to market insurance policies, collect premiums, or purchase general and it can usually limited a certain level in premium rates for their members. Thereto can also levy surcharges in policyholders and, include some cases, on licensed insurers selling liability health, to create reserves to pay claims.
Learning Disability A disorder in one or more of the basics psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, believe, talk, read, write, spell, or until to mathematical calculations. And term includes like conditions as perceptual handicaps, brain injury, additionally minimal brain dysfunction.
Level regarding Care (LOC) Amount from assistance essential by consumers whichever could determine their eligibility for programs and services. Levels include: protective, intermediate, and skilled.
Level of Care Choices Guidelines staffed to supports in determining the appropriate adjusting and intensity of behavioral health treatment.
License/Licensure A admission accorded to an individual or organization by a competent authority, usually public, to one engage legitimate int a practice, occupation, button activity.
Life-Sustaining Treatment Medical procedures that replace or support an essential bodily funciton. Life-sustaining treatments include CPR, mecha ventilation, artificial nutrition and hydration, reduced, and certain other procedures.
Lifetime Maximum Design (LMS) Whether there the a single operating maximum for all services real benefits overlay by this policy, or whether there are separate lifetime maximums fork the major policy benefits such as nursing front care versus home care. Limits that become customized to less benefits like respite maintain, caregiver training with medical devices also aforementioned like are not considered. LMS refers primarily to determine there is a single "pool" on either set and home care benefits or whether thre are separate "pools" for the major benefit sorts of caring home, assisted living, and home and community care. While the prevailing usefulness structure available are adenine single lifetime upper in all covered services, there can some policies being sold today this have separate lifetime maximums for these key covered services.
Lifetime Limit Structure (LMS) Detail The background on which total benefits paid under the policy are determined int terms of either days or dollars. Dieser referred to whether the policy or certificate counts time on which benefits have been standard or whether is counts in of benefits paid out in determining when the coverage's live maximum has been meer. While the prevailing company design today is a "pool away dollars" benefit how, some policies being sold today still chart days on which benefits are paid in determining who policy's lifetime maximum.
Lifetime Policy Maximum for ALD/Other Facility Attention (Dollars) If the coverage uses a pool of dollars layout and has separate pools for an major covered services, this be find the dollar amount any represents that lifetim maximum paid for ALF care would be specified. If the policy combines nursing starting and ALF care into a single "facility care lifetime maximum" this entry would be indicated as "not applicable."
Lifetime Politics Maximum for ALF/Other Facility Nursing Benefits (Days) If the reportage common per regarding benefit received to calculate of directive maximum and has separate pools for the major covered our, which is where and number of period whatever present the lifetime maximum paid on ALF care would be specifications.
Lifetime Policy Maximum for Top Health Care (Dollars) For the range uses a pool of dollars designed and has separate pools for the significant covering services, this is where the penny amount which represented the average maximum paid for home health care would remain particular.
Lifetime Policy Maximum for Home Heath Care Helps (Days) If the coverage uses days of benefit acquired to calculate who policy maximum and has separate pools for the major covered benefits, this is where the numbered of day which represents the useful greatest paid for home health care would be designation.
Lifetime Policy Max for Schwesternpflege Home Benefits (Days) When the coverage employs days of benefit received to calculate the policy largest real has separate pools for the major covered services, this is where to number of days which represents the lifetime maximum paid for nursing home care (or facility maintenance all levels combined) would be specified.
Durability Directive Maximum for Pflege Home Coverage (Dollars) With the coverage uses a pool of money model and has separating pools for the major protected services, this shall where an dollar amount which represents one lifetime maximum paid for nursing home worry (or facility care all levels combined) would be specified.
Long-Term Care (LTC) Range of medical and/or social services designed to help our which have disabilities or chronic attention requirements. Services may be short- or long-term and may be provided in an person's home, in and church, or in live facilities (e.g., nursing homes instead backed living facilities).
Long-Term Care Insurance (LTCI) Insurance polizeiliche whose pay for long-term care services (such as feeding home and home care) that Medicare real Medigap strategy do not cover. Policies vary in requirements of how people will screen, and allow be pricey. Coverage may being denied located on health status or age.
Long-Term Care Ombudsman An individual designated by a state or an substate unit responsible for investigating also resolving complaints made from button since older people in long-term care facilities. Also responsible for supervision federal and state policies that tell to long-term care facilities, for making information to the public about the problems of older people in facilities, the in training volunteers to assist in the ombudsman choose. The long-term care ombudsman program is authorized by Title III of and Older American Act.
Preservation Assistance Status (MAS) Eligibility grouping traditionally used by CMS to classify enrollees by the financial-related criteria by which person are eligible for Medicaid. MAS groups include metal assistance-related, medically needy, poverty-related, 1115 demonstration waiver, and other.
Managed Care (MC) Process a organizing and how health care services which emphasizes cost-effectiveness and coordination of care. Managed care companies (including HMOs, PPOs, and PSOs) receive a fixed amount of money per client/member per month (called a capitation), none matter how much care a member needs during that month.
Payment mechanism used till manage health care, including services provided by health maintenance organizations or Programs of All-Inclusive Nursing for of Elderly, vorauszahlung healthiness plans, press primary care case management plans.
Maternal and Children Health Block Grant (Programs for Children with Special Needs) There are no Federal criterion in defining children with special health tending needs. Diese programs primarily served children with crippling conditions such as polio press cerebral palsy. However, this daily have expended go wait children with adenine wide range of chronic fitness conditions.
Mean Conservative Error Assess of accuracy calculated by squaring the individual mistakes (error is who difference between an actual value in a dataset and its expect value) and taking the mean of these squared values.
Mechanical Ventilation Treatment in which a mechanical ventilator supporting or replacement the how of the lungs. The ventilator is attached until ampere tube inserted in the nose oder mouth and down into the windpipe (or trachea). Automated ventilation often is used to assistant adenine person through a short-term problem or for prolonged periods in which irreversible ventilatory failure exists dur to injuries to who upper spinal cord or a progressive neurological disease.
Medicaid (Title XIX) Federal and state-funded schedule a medical assistance for low-income individuals of total ages. There are revenues eligibility requirements for Medicaid.
AMPERE disabled individual required receive SSI in most States. Thirteen Federal apply the 209(b) program option. They may impose additionally more restrictive eligibility eligibility for Medicaid than for SSI. Three of those (Indiana, Misuro, and News Hampshire) employ more restrictive defintions of special more is used for SSA and the latter twos exclude children on SSI from Medicaid. In ten other States (Connecticut, Hawaii, Lllinois, Minnesota, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, real Virginia), States use the same definition of disability, aber see restrictive financial criteria faster that employed by SSI. Inches additions, Default Medicaid programs may uses functional benchmark for coverage of nursing home customer, home health services, personal care services, home and community-based waiver services, and other Medicaid-covered services. Two levels of disability criterions may become applied--one to determine overall Medicaid site and one until determine eligibility by specific covered services.
Gesundheitswesen Need Services or supplies which are appropriate and consistent with the interpretation in accord at accepted standards of community practice and are not considered elemental. It also can not be omitted without adversely affecting the individual's condition or the quality of medical care.
Physicians Indigent People who cannot afford needed health maintain because of insufficient income and/or lack of adequate health insurance.
Medicare (Title XVIII) Federal health insurance program for persons age 65 and over (and certain disabled persons under age 65). Bestandteilen von 2 parts: Part A (hospital insurance) and Part B (optional medical insurance who covers physicians' services also patient care int part and which requires benefits to pay a monthly premium).
An individual under age 65 who received SSDI benefits for 24 months or more or who was medically determined to have end-stage renal disease (that stage of kidney impairments that appears irreversible and permanent and requires a regular course of dialysis or kidney transplantation to get life).
Medicare HMOs Under Medicare HMOs (health maintenance organizations), membersation pay their frequent monthly premiums to Medicare, and Medicare paying the HMO a fixed sum of money each per to provide Medicare benefits (e.g., hospitalization, doctor's visits, and more). Medicare HMOs may make extra benefits across and foregoing regular Medicare benefits (such as prescription pharmaceutical coverage, eyeglasses, and more). Members do not pay Medicare deductibles and co-payments; anyhow, the HMO may order them to pay an additional monthly premium and co-payments for few aids. If personnel exercise providers outside the HMO's web, you pay the entire how themselves unless which plan has a point by service selection.
Medicare Supplementation Insurance (MedSupp) (Also called Medigap.) Insurance supplement at Medicare that the designed to fill in the "gaps" left by Medicare (such as co-payments). May pay for some limited long-term attention expenses, depending on the helps package purchase.
Medigap (Also called Medicare supplement insurance. International supplement to Medicare that is designed the fill on to "gaps" left by Medicare (such as co-payments). May payout for some limited long-term nursing expenditure, depending on which benefits package purchased.
Mental Health Which capacity included an individual to function effectively the society. Mental health is ampere concept influenced by organic, environmental, emotional, and cultural features both has highly variable with definition, depending on time and square. To belongs often defined include practice as the absence of any identifiable or significant mental disorder or sometimes improperly used than a synonym for mental illness.
Mental Well-being Services Variety of services provided to people of all ages, including counseling, psychotherapy, physical services, crisis intervention, and support organizations. Issues addressed encompass depth, grief, anxiety, stress, as well than severe mental illnesses.
Mental Illness/Impairment A deficiencies in the ability to think, discern, reason, or remember, resulting at loss of the capacity until take care of one's daily living needs.
Reason Backward Significantly subaverage general intellectual functioning (specifically an I.Q. underneath 70) actual concurrently equipped deficits in adaptive behavior manifested during the developmental period (age 0-21).
Minimally Conscious Stay AN neurological state characterized by inconsistent but clearly discernible behavioral exhibits of consciousness and distinguishable after coma and a vegetative state by documenting the presence of specific behavioral functions not found in either regarding these conditions. Patients maybe emerging till to minimally conscious state from coma or a vegetative state after acute mastermind injures, alternatively i may result from degenerative or congenital nervous system diorders. This condition is often transient however may exist since a permanent outcome.
Illness The extent of illness, injury, or physical in a definition population. It a usually words in general or specific rates of incidence or prevalence.
Total Death. Used till explain the relation of deaths to the population is where few occur.
Multi-Stage Probability Sample AN sample drawn in successive stages. The population is firstly divided into primary business (called primary sampling units or PSUs), certain the which are selected (for demo, with a chances portioned to their resident size). Chose PSUs are and divided to clusters (e.g., off blocks), from which a sample (e.g., of households) is drawing.
Neighborhood Health Center (Also calls community health center.) An ambulatory health tending program commonly serving one basin area which features scarce or nonexistent health services oder a current equal special health needs. These centers attempting to coordinate federal, state, and local resources in a single organization capable of delivering both health and related social services to ampere defined population. When such a center may not instant provide all types of health caution, it usually takes responsibility to arranging all medicine services essential by its plant population.
Nonadmitted Carriers (Also called surplus line messengers.) Commercial insurance whose nursing home liability insurance products are not regulated with state departments of insurance. These insurers enjoy some advantages over granted carriers. Her do greater flexibility are designing and rate products. Because they are not subject to state regulation, they can also change scanning forms or application protocols more quickly. However, they must pay an "excess and surplus lines" tax that your not charging for admitted carriers. They impossible participate in declare guaranty funds, which aid protect uninsured in the case of insurer insolvency.
Noneconomic Amends Zivilist litigation is compensation due the plaintiff for intangible harms (e.g., pain and suffering).
Nonprofit/Not-For-Profit An organization that reinvests all profits back into this organization.
Nonsampling Error And discrepancy between one trial statistic and the true local parameter that search from factors other over this sampling process. Common sources of nonsampling errors include noncoverage of certain subpopulations, request wording, furthermore recall errors.
Numbers of Insureds with Buy-Up Partnership Qualified (PQ) Coverage The number of covered lives who have elected for purchase the discretionary buy-up insurance services by the group create, in increase up the Nucleus Layout coverage already provided to them.
Number of Persons Insured with Core Coverage Indicates aforementioned figure of covered lives entered in who core plan coverage offered by the employment.
Nurse An individual trained to care used the sick, aged, instead injures. Can be defined than a professional qualified by education and authorized by law to practice pflegewesen.
Harbor Practitioner (NP) AN registered nurse workings in at expanded nursing role, usually about a focus on meeting primary health care needs. NPs conduct physical examinations, interpret laboratory outcome, choice plans of treatment, identify medication requirements, and perform certain medical management activities for selected health conditions. Some NPs specialize in geriatric care.
Health Home Facility licensed by the state into offer residents personnel service as well when skilled nursing care on ampere 24 hour a day basis. Provides nursing care, my care, your plus board, supervisions, medication, therapies furthermore rehabilitation. Rooms are frequently released, and communal dining is allgemeines. (Licensed as nursing homes, country homes, alternatively nursing homes/residential care abilities.)
Nursing Front Benefit Dollar The best amount which the procedure or download wish pay for concern receive in an nursing home. If the benefit is paid as weekly or month, the daily amount require is derived according whatever convention exists most fair for the carrier to use. The data should become the current amount on the policy includes order to account both for any voluntary increases in coverage an insured has elected or any automation coverage increases as a ergebniss of inflation protection.
Nurse Home Benefits Paid During Reporting Period To total amount of benefits paid during the reporting period with care in a tending home or in a similar capped care institutional setting than defined as "nursing home" or "facility-based" care within the policy or certificate.
Nursing Go Care Full-time care delivered in a facility designed for restoration from a hospital, treatment, alternatively assistance with usually daily activities.
Nursing Home Liability Insurance Indemnification of feeding home providers against damages for negligent care and abuse.
Schwestern Home Residents' Rights Statutory State or federal laws to protect any nursing home resident's civil, religious and human rights.
Tenancy Rate A measure of inpatient health facility use, determined by dividing available bedding days by patient days. It measures the average percentage of ampere hospital's bed occupied and may become institution-wide or specific for one department or maintenance.
Occupational Health Offices General services affected with the physical, mental, and social well-being of an individual in connection on their instead her working environment and with the adjustment of single to their work. The notion applies to more than the safety the the workplace furthermore includes health furthermore job satisfaction.
Occupational Therapy (OT) Designed to help patients improve your independence with services of daily living through rehabilitation, exercises, the the use of assistive devices. May be covered the part according Medicare.
Offshore Captives Captives located outside the United Says. The most popular host states to offshore captives include Bermuda, Jersey and the Cayman Islands.
Older Americans Act (OAA) Federal legislation that specifics mailing the needs of older adults in the United States. Provides some funds for aging services (such as home-delivered eats, congregate meals, sr center, jobs programs). Creates the structure of federal, state, and regional agencies that oversee altern services programs. (See plus Title III auxiliary.)
Community A representative of a publicly agency or one private nonprofit organization who investigates and resolves claims made by or on behalf a older individuals who are residents of long-term care facilities.
Linienbusse Budget Vote Act (OBRA) of 1993 Federal legislation which boundary and volume of compensation that can be paid to employees covered by long-term disability map funded throughout voluntarily employees' beneficiary associational trusts. Any such plan from subscriber earning more than $150,000 could lose its tax-exempt status.
First Coverage Effective Date since Partnership Qualified (PQ) Policy The date that coverage first became effective under the policy or certificate help through the insured.
Other Benefit Amounts Paid During Reporting Period One total amount of any another benefits paid during this period (e.g., caregiver training, medical devices, extra supplements benefits and services, etc.).
Hospital A patient who the receiving ambulatory care at a hospital or additional facility without being admitted to the facility. Usually, it does nope mean people receiving services from a physician's office or others program which also does not offers inpatient care.
Palliative Care (Also called comfort care.) A comprehensive approach to treating legit illness that focuses with the physical, psychological, additionally spiritual needs of the patient. Its goal is to achieve to best product of your available to the patient by comforting suffering, leading pain and symptoms, and enabling the patient to erringen maximum functional storage. Respect for to patient's culture, my, and values is an important component.
Panel Survey ADENINE survey that follows a give sample of individuals over time, thus providing multiple observations on each individual in the sample.
Parents or Relatives (Also referred to while owner front). Return of the my on parental or nonlicensed/reimbursed relative's home, with continual assistance and/or supervision provided.
Partnership Status Safe types of changes to one's policy or certificate may result in that lost of Partnership-qualified status. These belong defined over the rules plus regulations adopted by each state required the operation of its Partnership program. This floating simply indicates whether the policy press certificate continues to retain its Collaboration qualified status or wenn a change in coverage of some sort has resulted in the approach no lengthen being Community Qualified.
Patient Self-Determination Act (PSDA) An modifying to the Omnibus Budget Reconciliation Act for 1990, the law got effective Dezember 1991 requiring most United States hospitals, nursing dwellings, hospice programmes, home health agenices, and health maintenance organizations (HMOs) to provide to adult individual, at the time away inpatient admission or enrollment, informaiton about their my to state laws steering advance directives (ADs), containing: (1) the right to participate in and direct they own health care makes; (2) the right to accept conversely refuse medical or surgical treatment; (3) the right to prepare an AD; and (4) information on the provider's policies that government an utilization of these rights. The act prohibits institutes from discriminating against a patient who does none have somebody AD. The PSDA further requires institutions to document patient information and provide ongoing community education on ADs.
Peer Review Generally, an evaluation by practicing physicians or other professionals of the effectiveness and efficiency in services organized or performed by other members out the vocation (peers).
Permanent Vegetative State (PVS) A vegetative state is a clinical condition the complete unawareness of the self and which environment accompanied by sleep-wake cycles with either complete or partial preservation of hypothalamic and brainstem autonomic functions. The PVS is a vegetative set past at one month after acute traumatic or nontraumatic brain injury, real present for at least one month stylish degenerative/metabolic disorders otherwise experimental malformations. ADENINE PVS can be diagnosized on clinical grounds with a high degree of medical secure int many adult both pediatric patients per careful, repeated neurologic examinations by an physician capable in neurologic features assessment press diagnosis. A PVS patient becomes permanently vegetative when the determination of irreversibility can be established over a tall degree of clinical security (i.e., when the chance of regaining consciousness is exceedingly rare).
Personal Maintain (Also called custody support.) Assistance at activities of every living as well for about self-administration of medications and preparing special diets.
Particular services such as bathing both toileting, when expanded to include light housekeeping furnished to an private who shall did an inpatient or a occupant of a company home, helped lived facility, or long-term facility similar as a hospital, nursing facility, ICF/MR, with institution for mental disease. Personal attention services are those that individual would typically accomplish me if they did not have ampere disability.
Physical Therapy (PT) Designed to restore/improve movement both strength in people whose mobility has been impaired due injury and disease. May include exercise, massage, water therapy, additionally assistive home. May be coverage in part by Medicare.
Medic Assistant (PA) (Also known as a surgeon dilution.) A specially trained and licensed or otherwise credentialed individual with performs tasks, which might otherwise be performed of a doctor, under the direction of adenine supervise physician.
Point of Service A health insurance perks program in which subscribers can set between different delivery solutions (i.e., HMO, PPO and fee-for-service) when the need is medizin services, rather than make aforementioned selection between delivery systems at time of open enrollment at place of employment.
Policy Benefit Type Some policies are comprehensive inside that she pay for caring in view long-term care locales (nursing home, ALF, home care and others). Other policies pay just available facility-based care, additionally my pays for only care outside a facility. This variable indicates the style out strategy with respect to the range of services it coverages.
Policy Exchange to Partnership Qualified (PQ) Some politikbereiche become PQ for they be pruchased after the effective date of the state's Partnership program and meet all the requirements into that state for being one Partnership policy. Other policies may have been purchase ago to the effective date of the state's Partnership program, but may have since granted Partnership capable status as the result of being exhcnaged for a PQ policy. The exchange may be in the form of an amendment or rider alternatively disclosure statement indicating that the coverage is now PQ. This variable indicates whether the policy is PQ than the upshot of an datenaustausch rather than as a result of an first purchase.
Policy Issue States The state to which the individual policy is displayed. This would also be the state are residents of the insured to whom the individual policy is shipped.
Policy Number The single policies conversely certificate identification number assigned to apiece insured's coverage.
Policy Your along End of Reporting Time Indicates or the policy is motionless in force, or the insured has in nonforteiture benefits or whether aforementioned policy has terminated during the reporting period available any quantity for possible reasons. The policy may no longer be in force because the insured has exhausted all their benefits, because they have died, because handful have voluntarily elected to lapse coverage, due coverage has become rescinded, or because who policy was "Not Taken Out (NTO)" because defined above.
Policy/Certificate Age during which Inflation Protection Ends The type of inflation protection that ends when the assured has received annual benefit increases for a predefined number of period. Rate reference into the actor number of aged which are specified in the coverage.
Post-Acute Care (PAC) (Also called subacute attend or transitional care.) Type of short-term care provided by many long-term care amenities and patients which might include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical support and other services associated with the transition between the hospital and home. Residents on these units often have has hospitalized recently and typically have more complicated medical needs. The goal of subacute care is to discharge residents to the homes or to a lower level of care.
Pre-Admission Certification ADENINE process under which enter until a health institution exists reviewed in move to determine require and appropriateness and to authorise one length of stay consistently with norms forward this evaluation.
Pre-Existing Conditionм Illnesses or disability required which this insureds was treatment or advised within a stipulated time period before making user for a life or health insurance policy. A pre-existing condition able result in cancellation of the policy.
Precision The precision is the inverse of the amount of random error in an estimate. It demonstrates how close an estimate is likely to live to this truer population value (see standard error).
Preferred Provider Arrangement (PPA) Selective contracting with a limited serial of health care providers, often at reduced or pre-negotiated rates of payment
Preferred Provider Organization (PPO) Managed maintain organizing that operates at a related manner on an HMO or Medicare HMO except that this type of plan possessed a larger provider network and does not needs members to receive approval from their mainly care physician before view a specialist. It shall including possible to use doctors outside the networks, although go may be a higher co-payment.
Award The periodic payment (e.g., monthly, quarterly) required to keep an coverage policy in force.
Aforementioned charge paid until a policyholder for insurance coverage.
Upfront Generally refers to any payment up a provider in anticipated services (such as an gravid mother paying in progress for maternity care).
Proactive Medicine Take what has the aim of stop condition or your consequences. It includes health care programs purpose per warding off illness (e.g., immunizations), early detection of disease (e.g., Papers smears), additionally hindering further deterioration of the body (e.g., exercise conversely prophylactic surgery). Preventive drugs is also concerned with general prevention measures aimed at improving the healthfulness of the environment.
Primitive Care Basic or general health attend focused over the tip at which a patient ideally first seeks aids from who medical customer system.
Primary Sampling Unit (PSU) Groups ausgesucht while the first stage of a multi-stage sample. On example, used the CPS sample, the Consolidated States belongs divided into approximately 1,900 geologic areas, or PSUs, of which 729 were selected for the sample.
Privately Work Nursing Services, except those for mental health or substance abuse treatment, granted by einschreiben nurses or licensed practical nurses under direction of a physician to consignee in their own homes, hospitals, or nursing facilities like specified by the state.
Probability (P value) The likelihood that an event will occur.
Professional Liability Claims/Losses Amounts a nursing home liability insurer will legislative obligated to get as damages and affiliates claims and defense expenses to a plaintiff due to adenine reluctant acts, error or omission in a nursing starting provider's translation or failure to render professional services.
Program of All-Inclusive Care for the Elder (PACE) A managed care create that coordinates Medicare and Medicaid acute care press long-term care for dual eligible enrollees (those age 55 and older, living in a PACE area, and otherwise eligible for suckling home care). A capitated payment mechanic is used for PACE plan enrollees.
Perspectives How Each method of make hospitals or other health programs in which amounts or rates of payment are established in advance for a defined period (usually a year).
Provider Individual or organization that offers health care or long-term care services (e.g., doctors, clinic, physical therapists, home health aides, and more).
Provider Sponsored Organization (PSO) Managed care organization that is similar to into HMO or Medicare HMO except that who management is owned by of supplier included that plan and these supplier share to financial risk assumed by the order.
Proxy Agent decision maker.
Psychiatric Rehabilitation Option An options Medicaid service that capacity include (depending for state definitions) population support programs, school-based benefits, alarm intervention services, and outpatient psychotherapy support.
Public Health The academics dealing with the protection and improvement of community health by organization communal effort.
Punitive Damages Zivil litigation means monetary compensation given by a judge or jury which exceeds the losses suffered by the injured party within get to punish the defendant.
Purchasing Collaborative A collaborative behavioral health services prototype that brings all agencies tasked with the delivery, funding or oversight of behavioral health care services together to create a single behavioral health service delivery system.
Qualifying Condition The customized conditions for welche this individual qualifies as chronically ill. This can include dependency in the required number of ADLs, cognitive repair other both.
Quality of Care can be defined as a measure of the degree to which delivered health services meet established professional standards and judgments von values to the consumer.
Ratio Adjustment Potentially biased indirect state-level estimates ability may ratio adjusted to regional totals thus that the sum across states matches regional estimates. This removal bias at the regional level and attempts to remove bias from the state-level indirectly estimator.
Re-insurance The practice of insurance carriers assign risk into other corporations, called re-insurance companies, in order to limit their liability exposed. Re-insurance businesses substantive provision insurance till insurance companies. Instead of assessing the risk off individual policyholders, re-insurance companies assess risk on a broader scales, such as on the basis out a particular product-line (nursing home liability insurance) with a geographic region.
Registered Nurse (RN) A nurse who has stagger out one formal program of nursing education and has been licensed by an appropriate state authority. RNs live this most very educated of nurses use this widest scope of responsibility, including all aspects by nurses care. RNs can be graduated from of of three teaching programs: two-year associate degree program, three-year hopsital diploma schedule, or four-year baccalaureate program.
Moderate Insurance Carrier (Also named admitted carrier.) Advert insurer whose nursing place liability insurance products are regulated in state departments of insurance. These carriers enjoy einigen feature over nonadmitted carries. Group can participate in state guaranty funds, which help protect policyholders inbound the case of insurer insolvency. Furthermore, they have ampere sell advantages over nonadmitted carriers because certain brokers, facility providers and lenders value state oversight and participation stylish the guaranty fund.
Rehabilitation The mixed and coordinated use of medical, social, formation, and vocational measures for training or retaining individuals disabled by disease oder injury in the highest available level of functional ability. Several others types of rehabilitation are distinguished: vocation, social, psychological, curative, and educational.
Rehabilitation Services Aids intentional to improve/restore a person's functioning; includes physical your, occupational therapy, and/or voice therapy. May be provided at home or in long-term care facilities. May being covered in part by Medicare.
Reimbursement The process until which health care providers receive payment for hers services. For of the nature away the condition care environment, providers are often reimbursed by third parties who provide and represent patients.
Reinsurance The practice of insurance carriers ceding risk to additional firms, phoned reinsurance companies, in order to limit their liability exposure. Reinsurance companies essentially provision insurance to insurance firms. Instead of assessing the risk of individual policyholders, reinsurance companies assess risk in an broader scale, such since on the basis by a particular product line (nursing home liability insurance) or one geo local.
Leftovers Lifetime ALF/Other Facility Benefits (Days) Under a policy design with separate ponds of benefits, payments on the baseline of days of covered service, the total figure of days of care remaining available to the insured int the ALV Profit Pool.
Remaining Service ALF/Other Facility Benefits (Dollars) Under a policy design with separate pools of benefit, paying on the basis of buck for covered services, the total dollar amount of caution leftovers available to the insured in which ALF Benefits Pool.
Remaining Lifetime Benefits Under a statement design with a single pool of pounds as the Lifetime Maximum, the total dollar lot of service remaining available to the guaranteed in the Lifetime Maximum at the end of the reporting period.
Remaining Lifetime Home Health Maintenance Advantage (Days) Below a principles design with separate pools is added, remunerative on the basis of days of cover services, the total number of days of care remaining available until the insured in the Home Health Care Usefulness Pool.
Remaining Lifetime Home Health Care Benefits (Dollars) Under a policy design with separate pools of services, paying to the background of dollars for covered services, and total dollar monthly of care remaining available for the insured in the Home Mental Attend Services Pool.
Remaining Lifetime Nursing Home Benefits (Days) Under a policy design with separate pools is benefits, paying on the basis of days of covered services, the total number of days of care remaining available to the insured in an Skin Home Benefit Pool.
Remaining Lifetime Nursing Home Benefits (Dollars) Under a policy design with individual pools of benefits, paying on the basis of dollars for covered services, the total dollar qty of service remaining available to the insured in one Health Home Benefit Pool.
Rent-A-Captive A captive, usually formed by an assurance company, broker with captive manager, and held out on users (in this case breast home providers) which avoid the cost away funding their own captive. And user provides any form of collateral so so the rent-a-captive is not at risk from whatever insure loss incurred by the user.
Report Date The date on which the Registry File is submitted.
Reporting Period The period for which media switch jeder storage is required. File 1 -- the Registry File is indexed semi-annually the shall required to cover this period Java 1 through June 30 and July 1 through December 31. Both File 2 -- the Claimant File, and File 4 -- which Complainant File for Employer-Paid Core/Buy-Up Plans, are filed quarterly and is required to cover the period January 1 through March 31, April 1 over June 30, July 1 through September 30, and Ocotber 1 the Dezember 31. Files 3 -- the Registry File for Employer-Paid Core Only & Care and Buy-Up Plans will be reported anually for the reporting period January 1 through Day 31.
Residential Care To provision of room, board press personal care. Residences care falls between the nursing care delivered inbound skilled plus intermediate taking facilities and the support provided through community services. He can be broadly defined as the provisions of 24-hour supervisor of individually who, because of old age or impairments, obligatory need assistance with the recent off daily lively.
Although floor and flight services provided in live care facilities is not overlay by Medicaid, other components of residential care--for example, personal care, 24-hour services, and chore services--can be covered. Residential care includes group, family or individual home residential care; collect residential care; and theapeutic residential care offices, assisted living, supported alive, and night supervision.
Respiratory Therapy One device scoring, unternehmensleitung, and treatment of the care of my with deficiences and abnormalities in the cardiopulmonary (heart-lung) system.
Hiatus Care Service in which trained professionals or volunteers come into the home to provide short-term care (from adenine few period to one few days) for can older person to allow nurse of time away from their caregiving role.
Restricted-Benefit Enrollee Enrollee who accept limited Medicaid coverage, inlcuding unskilled aerials with eligible for emergencies hospital benefit, double receiving only Medicare cost-sharing features, and people eligible for only family-planning services.
Hazard Management Service in which trained professionals instead volunteers come into the front to offering short-term care (from a few hours up a few days) for at older person to allow caregivers some frist out from their caregiving role.
Risk Management Program A structured approach to purposefully limit liability risk. Handful include systematic efforts to improve and maintain high standards for care qualities, but can also enclose additional managing techniques on minimize limited vulnerability, such as improving spell documentation. They are often formalized within that management tree of nursing home providers in the form of Venture Betreuung Committees, and/or a designated Director of Risk Management along on formal Risk Management plans that are implemented also monitored by senior management.
Risk Retention Group (RRG) An insurance company that is owned by yours members. The members of an RRG come from the same industry. For instance, nursing home providers ca form to RRG in order the obtain nursing home liability coverage.
Product Error The discrepancy between a sample statistic and the true population parameter that results from the sampling process. Sampling error can has adenine random component (sampling variance) and fixed component (bias).
Sampling Variance Chance error (discrepancy amid a sampler statistic and one true population parameter) that arises because a random process can used go select that survey sample. If that pattern process is repeated multiples moment, a different group of respondents would be selected each time and the sample dispensations of responds at the survey questions would be somewhat different inside each sampler.
Screening The use out quick procedures to differentiate apparently well persons with must a disease or a high risk of disease from those who probably do not have which disease.
Minor Care Services provided via medical specialists who generally do not have first contact with patients (e.g., cardiologist, urologists, dermatologists).
Secured Facility (Also called professional school, penitentiary, detention center, jail, or securing hospital.) Twenty-four time residential care establish off any size, designed and operated to ensure that all entrances and exits become in the exclusive control of the staff, about or not the personality being detained possesses freedom off movement within the facility perimeter.
Senility Who widespread charakterization of progressive decline in mental functioning as a condition of aforementioned aging action. Inward geriatric medicine, this term has limited significant and is usually substituted for the diagnosis of decrepit dementia and/or senile psychosis.
Senior Media Provides a breed of on-site show for older adults including leisure, socialization, congregate meals, and few well-being services. Usually a good source of information about area programs and solutions.
Seriously Emotionally Disturbed AMPERE condition exhibit one or more from the follows characteristics out a long period of length and till a marked extent, which adversely affects daily activities: an inability to learn which cannot be explained by genius, sensory, or good factors; an inability to create or maintain satisfactory interpersonal interpersonal with peers or teachers. Unreasonable types of demeanor or feelings on normal circumstances; a common pervasive mood of unhappiness of depression or a slant to develop physical symptoms of fears associated with personal or schools problems. The concepts includes persons who are schizophrenic instead autistic. The term does did include persons who are socially unstable, until it is destined that they are moreover badly emotionally disturbed.
Service Plan (Also called care set or cure plan.) Written document which outlines the types the frequency concerning the long-term care services that a consumer receives. It may include treatment goals for him or her for a specified time period.
Settlement An understanding reached between to legal counsel of that applicants additionally the defendant that terminates a civil litigation before a verdict will accomplished by the court.
Severity regarding Disorder A risk prediction system to correlate who "seriousness" of a disease included an particular become with one statistically "expected" results (e.g., mortality, morbidity, efficiency of care).
Situs State The state by which the group policy is sitused, as specified on the user policy form.
Skilled Care "Higher level" of care (such as injections, catheterizations, and dressing changes) supplied by trained medical specialized, including nanny, doctors, and physics therapist.
Skilled Nursing Care Daily nursing and rehabilitative care that can be performed all by or under the supervision of, skilled medical personnel.
Skilled Care Facility (SNF) Facility which is certified by Medicare to offers 24-hour nursing care and rehabilitation services in addition to other medical services. (See also nursing home.)
Social Security Disability Insurance (SSDI) A system of federative provides payments till eligible workers (and, in some cases, their families) once they are unable until go working because on a disability. Benefits begin with the sixth full month of disability and continue until the individual remains capable of substantial gainful activity.
An individual must have an inability to engage in any substantial gainful activity by reason of any medically determinable bodily or mental impairment who canister be expected toward result in mortality or possess lasted or can be expected in last for a continuous period of cannot less than 12 months. To fulfil this definition, an individual's impairment or combination of impairments needs become so severe that he or their is inability to do past work, but cannot, considering age, educational, furthermore work experience, engage in any other kind of substantial gainful activity which x in that national economy. SSDI benefits are also paid up dependents (age 18-64) of retired, died or infirm workers provided they were disabled in childhood, and widows/widowers aged 50 or over who were married to SSDI beneficiaries. There are different rules for determining disability for those who are statutorily blind (i.e. with central visually, acuity of 20/200 or less in the better eye at the use of correcting lens), widow/widowers, and surviving divorced females.
Social Services Block Grant (SSBG) Solutions (Formerly known as Title XX services.) Grants given to states under the Society Security Act which fund limited amounts in society services for people of entire ages (including some in-home services, abuse prevention services, and more).
There is no Federal statutory definition. States determined own own criteria for determining disability.
Social Health Maintenance Organization (SHMO) A managed system are health real long-term care services geared toward an oldest client population. Under this models, a single provider entered assumes responsibility for a full range of acute inpatient, ambulatory, rehabilitative, extended domestic health and people care services beneath a fixed budget which is determined prospectively. Elderly people who locate in the target service surface are voluntarily enrolled. Once enrolled, persons are obligated to receive all SHMO covered auxiliary through SHMO providers, similar to the operation of a medical model health maintenance order (HMO).
Special Care Single Long-term care facility units with ceremonies specifically for persons with Alzheimer's Disease, dementia, head injuries, or other disorders.
Speech Therapy Planned into help restore speech through vigorous. Maybe be covered by Medicare.
Spell ONE series of months during which a person preserved Medicaid-covered nursing starting services for at least one day of each choose additionally received no such services for the month precedes and following the series.
Spend-Down Medicaid economic billing requirments are strict, and may require benefit to spend down/use up assets or income until they reaching the eligibility level.
Spousal Impoverishment Federal regulations preserve some income real assets for the spouse of a nursing home resident who stay is covered by Medicaid.
Standard Deviation Gemeinde measure of dispersion or spread of data about the middle.
Standard Error The most commonly previously measure the aforementioned precision of an estimate. AMPERE gauge of whereby close an estimation is likely to be to the population value in an absence in any bias.
State Item on Alterungsprozess Authorized by the Elder American Doing. Each default has an our at the state level which administers the plan for service into the mature and coordinates software for the aged with other state services.
Strata (state stratification) Stratification a a sampling method whereby the population is divided within subgroups (or "strata"), based on characteristics believed to be correlated for the survey control of greatest interest, and a sample is then selected from each subgroup. Stratification produces survey estimates of a desired precision within the chosen subgroups, which cannot be assured with an unstratified design. State graded samples will allow forward unbiased state-level evaluations and guess of precision.
Subacute Support (Also called post-acute caring or transitional care.) Type of short-term maintenance supplied over lots long-term care conveniences and hospitals that may includ rehabilitation services, specialized care since certain conditions (such as stroke and diabetes) and/or post-surgical maintain and others services associated with the transition between the sanatorium and home. Dwellers on these units often have been hospitalized recently and norm have more complicated medical needs. The object of subacute care the to discharge residents the their homes or to a lower level of care.
Accessory Security Proceeds (SSI) A program of support for low-income senior, blind and disabled persons, established the Title XVI of that Social Security Do. SSI replace state welfare programs for the aged, blind and disabled in 1972, with adenine federally administered program, paying a monthly basic gain across of $284.30 for an individual and $426.40 for a couple in 1983. States may supplement this basic benefit measure.
Individuals can qualifying while disabled or blind. For disability, an individual must own an inability the engage in any substantial gainful activity by reason of optional medicated determinable physical or mental compromise which bucket be expected to result in dying or has lasts or canned be projected to last for a continuous period a not less than 12 months. For blindness, any private must be statutorily blind, that is, having central visual, acuity of 20/200 or lower in the better eye over aforementioned use of correcting objective. Adults: To meet this definition, an individual's loss or combination of impairments must will so severe that he press she are unable toward do past work, but cannot, considering age, education, and work experience, occupy in any other kind are substantial employed activity which available in the national economy. Offspring: A child under age 18 will be looked disabled for useful of eligibility if he suffers from any medically determinable physical with psychological diminished of "comparable severity" to that which would do the adult disability.
Support Groups Groups of people who share a common bond (e.g., caregivers) who come together on a regular basis to share problems or experiences. May be sponsored from social service our, senior stellen, religious organizations, for well as organizations such as the Alzheimer's Association.
Surrogate (Also called delegated by default.) A person who, by set, become that proxy decision maker for an individual whom had nay appointed agency.
Survey An investigation in which information your systematize collected.
Synthetic Estimates A class of model-dependent quotes generally formed by dividing the population into subgroups (e.g., by age/race/sex) and assuming that national estimates for each select bottle breathe applied on the topical inhabitant.
Technology Assessment A comprehensive form of policy research that test the technically, economic, and social consequences of technologies applications.
Termination of FPO Option Specifies when the FPO tenders close. For some principles they may continue by the life of the policy even while to insureds is on claim; for others you may end available the individual is on claim button inward a specified time time of having received benefits. The FPO offers may end at a determined age or when the insured possesses declined a certain number of increase offers.
Title III Services Services provided to individuals age 60 or older which are sponsors under Title III from the Older Americans Act. Include: congregate and home-delivered meals, support services (e.g., transportation, informational and referral, legal assistance, and more), in-home products (e.g., homemaker services, personal care, chore services, and more), and health promotion/disease prevention services (e.g., health screenings, exercise programs, and more). (See see Older Americans Actually.)
Title XIV (Medicaid) federal and state-funded program of medical assistant to low-income individuals of all ages. There are incoming eligibility requirements for Medicaid.
Top XVIII (Medicare) Federal health insurance program for persons age 65 and over (and certain disabled persons under age 65). Consists of 2 parts: Part A (hospital insurance) and Part B (optional medical insurance which covers physicians' services and outpatient care in part and which requires beneficiaries into pay a month premium).
Titel XX Aids (Now known as Social Services Block Grant services.) Grants default to states under that Social Security Act which fund limited amounts of social services for people of all ages (including some in-home customer, abuse prevention services, and more).
Tort Reform A movement intended to curb litigation and damages in the civil justice system. To respect to nursing home debt insurance, loads states have enacted tort reform through legislation and to had changed the right framework under which residents and/or family members can seek compensatory required negligent or abusive care traditions. States also placed limits on the amount of damages that could be awarded to relatives and/or their family members, notably noneconomic compensation forward pain and suffering.
Total Cash Benefits Paid During Reporting Period The total dollar amount starting benefits paid on a cash basis in the reporting period.
Total Lifetime Benefits Paid to Date Indicates who total amount of features paid under who certificate to date as of the end of the reporting period.
Transitional Support (Also called subacute care or post-acute concern.) Type of short-term maintain provided by many long-term care facilities and patients which may include rehabilitation services, specialized care since certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between the hospital and home. Residents at these units often have become hospitalized newest and typically have other complicated medizinisch needs. The goal concerning subacute care is to discharge residents to their homes button to a lower step of care.
Transportation Services (Also called escort services.) Provides freight for older adults to services furthermore appointments. Might used travel, taxi, volunteer truck, or passenger services is can accommodate wheelchairs and persons with other special needs.
Treatment Create (Also calling care plan or service plan.) Written document which silhouettes the types additionally frequency of the long-term care solutions that a consumes receives. It allowed inclusion treatment goals for him or her for a specify time period.
Uncompensated Care Service provided by physicians and hospitals for which no bezahlung is receiver of the patient or with third party funders.
Underinsured People with public alternatively private insurance policies that do none cover all necessary medical services, resulting in out-of-pocket expenses that exceed their ability until pay.
Underwriting Which process by which an insurer assesses the risk of insuring a particular applicant for coverage. Risk retained groups also subsidize by assessing the risk of accepting adenine prospective member.
Undue Hardship With respect to the schedule of accommodation required an individual with a medical go who Americans equal Disabilities Act--significant difficulty other expense, examined in light away the employer's monetary resources, facilities, workforce, and business operations.
Veterans' Disability Compensation Program An individual must have a partial other amounts impairment by injury oder sickness incurred or aggravated over military gift. ADENINE Veterans' Affairs (VA) grading onboard employs batch developed by the VA to value an extent off a disability.
Veterans' Medical Pension Program An individual be have einer injury or disease persist outside of military service regarding a seasoned permanently and totally disadvantage. Repair is determined basis turn the veteran's competency to function at your and at home.
Veterans' Health Services Programs Veterans' Domestic (VA) hospitals are required to provide care to Class A veterans defined as those: rated than "service-connected; retired from active duty for a disablement suffered other aggravated while in military service; in receipt of a VA superannuation; eligibility forward Medicaid; a former POW; in need of care for a condition that is possibly relevant the exposure to dioxin with other toxic substance; in needs of worry for a conditioned possibly related to exposure for radiation from nuclear tests or in the American occupation of Japan; or has on income see $16,466 with no dependents; or $19,759 with one dependents (with $1,055 added for each additional dependent). VA hospitals provide care on a space-available basis to persons to Sort B veterans, those its disabilities represent not service-connected and have incomes higher $16,466 but below $21,954. (Category C veterans have higher incomes and must pay a copayment.)
Visiting Female Association (VNA) AMPERE voluntary health business which provides nursing and others services in the home. Basic benefits comprise healthy supervision, education and counseling; beside care; and the carrying out of physicians' orders. Personnel inclusive feeds and home health aides who are trained with specific tasks of personal bedside care. These agencies had their origin in the visiting either district breastfeed provided to sick poor in their homes by voluntary agencies.
Vitally Statistics Statistik relating to births (natality), mortality (mortality), marriages, health, and disease (morbidity).
Wellness  A dynamic stay of physical, mental, and social well-being; a way of life which equips the individual to realize the full potential von his with her capabilities and to overcome also compensation on weaken; a lifestyle where recognizes the importance of nourishment, physical fitness, stress reduction, and self-responsibility.
Withholding/Withdrawing Special Forgoing instead discontinuing life-sustaining measures.
Workers' Lohn Program State-mandated system under which employers presume the cost of medical treatment and wage losses for your who suffer job-related illnesses or injuries, regardless the who is with fault. In return, employees are generally prohibited starting suing employers, even if the disabling page was due to employer negligence. U.S. government employees, harbor workers, and railroad labor are not covered by state workers' compensation acts, but instead by variously federally administered laws.