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A

ACA: Affordable Care Act

ACL: Administration for Community Living

ACO: Accountable Care Organization

ACS: Alternative Care Settings

ADHC: Adult Day Health Care

ADL: Activity of Daily Living

ADRC: Aging and Disability Resource Center

ADSP: Adult Day Service Program

AHRQ: Agency for Health Care Research and Quality

ALF: Assisted Living Facility

ANOC: Annual Notice of Change

ANOC/EOC: Annual Notice of Change/Evidence of Coverage

AoA: Administration on Aging

APM: Alternative Payment Model

ARRA: American Reinvestment and Recovery Act of 2009

 

B

BAA: Business Associate Agreement

BBA: Balanced Budget Act of 1997

BEQ: Beneficiary Eligibility Query

BIPA: Benefits Improvement and Protection Act of 2000

BIPP: Balancing Incentives Payment Program

BPT: Bid Pricing Tool

 

C

CCRC: Continuing Care Retirement Community

CDC: Centers for Disease Control and Prevention

CDS: Common Data Set

CFR: Code of Federal Regulations

CHIP: Children's Health Insurance Program

CMMI: Center for Medicare and Medicaid Innovation

CMP: Civil Monetary Penalty

CMS: Centers for Medicare & Medicaid Services

CMS CO: CMS Central Office

CMS RO: CMS Regional Office

CPT: Current Procedural Terminology

CQI: Continuous Quality Improvement

CY: Calendar Year

 

D

D-SNP: Dual Eligible Special Need Plan

DIR: Direct and Indirect Remuneration

DMAIC: Define, Measure, Analyze, Improve, and Control

DMAO: Division of Medicare Advantage Operations

DP2: DataPACE2

DSA: Data Services Agreement

DSCR: Debt Service Coverage Ratio

DSRIP: Delivery System Reform Incentive Payments

 

E

EBITDA: Earnings Before Interest, Taxes, Depreciation and Amortization

ED: Encounter Data

EHR: Electronic Health Record

EOC: Evidence of Coverage

EP: Eligible Professional

 

F

FAI: Financial Alignment Initiative

FDA: Food and Drug Administration

FFS: Fee for Service

FIDESNP: Fully Integrated Dually Eligible Special Needs Plan

FMAP: Federal Medical Assistance Percentage

FPG: Federal Poverty Guidelines

FQHC: Federally Qualified Health Center

FTE: Full-Time Equivalent

FY: Fiscal Year

 

H

HCBS: Home and Community-Based Services

HCC: Hierarchical Condition Category

HCPCS: Healthcare Common Procedure Coding System

HEDIS: Healthcare Effectiveness Data and Information Set

HH: Home Health

HHA: Home Health Agency

HHS: U.S. Department of Health & Human Services

HICN: Health Insurance Claim Number

HIPAA: Health Insurance Portability and Accountability Act of 1996

HIT: Health Information Technology

HITECH: Health Information Technology for Economic and Clinical Health Act

HMO: Health Maintenance Organization

HOS: Medicare Health Outcomes Survey

HOS-M: Health Outcomes Survey: Modified

HPM: Health Plan Management

HPMS: Health Plan Management System

HRSA: Health Resources and Services Administration

HUD: U.S. Department of Housing and Urban Development

 

I

IADL: Instrumental Activities of Daily Living

IBNR: Incurred But Not Reported

ICRC: Integrated Care Resource Center

IDD: Intellectual and Development Disabilities

IDT: Interdisciplinary Team

IHS: Indian Health Service

ILC: Independent Living Center

IRF: Inpatient Rehabilitation Facility

 

L

LEP: Limited English Proficiency

LIS: Low-Income Subsidy

LTC: Long-Term Care

LTPAC: Long-Term Post-Acute Care

LTSS: Long-Term Services and Supports

 

M

MA: Medicare Advantage

MACRA: Medicare Access & CHIP Reauthorization Act of 2015

MAO: Medicare Advantage Organizations

MBI: Medicare Beneficiary Identifier

MC: Managed Care

MCO: Managed Care Organization

MDS: Minimum Data Set

MFP: Money Follows Person

MIPPA: Medicare Improvements for Patients and Providers Act

MIPS: Merit-Based Incentive Payment System

MLTSS: Managed Long-Term Services and Supports

MMA: Medicare Prescription Drug, Improvement and Modernization Act

MMCO: Medicare-Medicaid Coordination Office (CMS Duals Office)

MMP: Medicare-Medicare Plan

MMR: Monthly Membership Report

MOEG: Medicare Parts C and D Oversight and Enforcement Group

MOR: Model Output Report

MSP: Medicare Savings Program

MSP: Medicare Secondary Payer

MU: Meaningful Use

 

N

NH: Nursing Home

NORC: Naturally Occurring Retirement Community

NP: Nurse Practitioner

NPA: National PACE Association

NPI: National Provider Identifier

NQF: National Quality Forum

 

O

OAA: Older Americans Act

OASIS: Outcome and Assessment Information Set

OCR: Office for Civil Rights

 

P

PA: Physician Assistant

PACE: Program of All-Inclusive Care for Elderly (PACE®)

PBM: Pharmacy Benefit Manager

PBP: Plan Benefit Package

PCP: Primary Care Physicians

PDAC: PACE Data Analysis Center

PDCA: Plan, do, check, act

PDE: Prescription Drug Event

PDSA: Plan Do Study Act

PECOS: Provider Enrollment, Chain, and Ownership System

PFFS: Private Fee-For-Service Plan

PFS: Physician Fee Schedule

PHI: Protected Health Information

PMPA: Per Member Per Annum

PMPM: Per Member Per Month

PPR: Plan Payment Report

PO: PACE Organization

PPO: Preferred Provider Organization

PQRS: Physician Quality Reporting System

PTMPA: Per Thousand Members Per Annum

PY: Payment Year

 

Q

QAPI: Quality Assessment Performance Improvement

QI: Quality Improvement

QMB: Qualified Medicare Beneficiary

 

R

RAPS: Risk Adjustment Processing System

RCFE: Residential Care Facilities for Elderly

 

S

SAE: Service Area Expansion

SAMHSA: Substance Abuse and Mental Health Services Administration

SGR: Sustainable Growth Rate

SIM: State Innovation Models

SLMB: Specified Low-Income Beneficiary

SNF: Skilled Nursing Facility

SNP: Special Needs Plan

SSA: Social Security Act

SSA: Social Security Administration

SSDI: Social Security Disability Insurance

SSI: Supplemental Security Income

SSN: Social Security Number

 

T

TIN: Taxpayer Identification Number

TPA: Third Party Administrator

TRC: Transaction Reply Code

TRR: Transaction Reply Report

 

U

UPL: Upper Payment Limit

 

V

VACO: Veterans Affairs Central Office

VAMC: Veterans Affairs Medical Center

VBP: Value-Based Purchasing

VISN: Veterans Integrated Service Network

VM: Value-Based Payment Modifier

VPN: Virtual Private Network

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