A
AAA – Area Agencies on Aging Organizations designated by the state to address the needs of elderly citizens within that a specific geographic region to help them live independently.
ABP – Alternative Benefit Plan are specifically tailored health care plans that are developed to meet the needs of specific Medicaid populations, of residents in a specific geographic region, or provide services through a specific system vs the traditional Medicaid benefit plan.
ACA – Affordable Care Act was enacted in March 2010 to make health insurance affordable and available to more people. The Affordable Care Act also expand the Medicaid program to cover more adults living 138% below the federal poverty level.
AHEAD – All-Payer Health Equity Approaches and Development is a model that CMS developed to collaborate with states to slow health care costs while improving health outcomes and advancing health equity.
AHEC – Area Health Education Centers have developed health curriculums for pre-college level students and work to place them in a variety of settings such as rural, migrant, and urban medical settings. AHEC’s also provide accredited continuing education programs to healthcare professionals.
ALOS – Average Length of Stay refers to the number of days, on average, an individual stays in a hospital.
ASAM – American Society of Addiction Medicine is a society comprised of medical professionals that specialize in Addiction Medicine. The ASAM advocates to improve access to treatment, as well as provides educational opportunities to further advance the awareness and knowledge of evidence-based addiction treatments.
B
BH – Behavioral Health references both mental health and substance use disorders, crisis, and stress-related physical symptoms.
BNE – Bureau of Narcotic Enforcement monitors and regulates prescription-controlled substances in an effort to stop the illegal use and trafficking of these controlled substances.
BRFSS – Behavioral Risk Factor Surveillance System collects health-related state data via telephone surveys regarding health-related risk behaviors, chronic conditions, and the use of preventive services.
C
CAHPS – Consumer Assessment of Health Care Providers and Systems are surveys that ask consumers and patients to report on and evaluate their experience with health care. The surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services.
CBES – Children’s Health Insurance Program Budget and Expenditure System is a platform used to report on budgeted and actual expenditures for the Children’s Health Insurance Program (CHIP) and Medicaid. This platform is used by state Medicaid agencies to report to CMS.
CBO – Community Based Organization is a public or private non-profit (including a church or religious entity) that is representative of a community or a significant segment of a community, and is engaged in meeting human, educational, environmental, or public safety of the community.
CCM – Care Coordination Model are designed to enhance the quality and efficiency of healthcare delivery through a patient-centered approach. These models aim to integrate care across various settings and providers.
CDC – Centers for Disease Control and Prevention is a federal agency responsible for administering Medicare and overseeing state administration of Medicaid.
CDPAP – Consumer Directed Personal Assistance Program allows individual to recruit and hire their own home health aides, which can be a family member or friend. This program is a NYS program that focuses on those living with chronic medical conditions or physical disabilities that have trouble with daily living activities and need extra support at home.
CFCO – Community First Choice Option is a state Medicaid plan option that allows for long-term services and supports to individuals needing help with everyday activities and health-related tasks.
CFR – Code of Federal Regulations are codified general and permanent rules that are published in the Federal Register by Federal departments and agencies.
CHIP – Children’s Health Insurance Program provides low-cost health insurance coverage for children in low-income families (those that earn too much to quality for Medicaid).
CIB – CMCS Informational Bulletin was created by the Centers for Medicaid and Medicare to share information, highlight best practices, and address any operational or technical issues to state Medicaid agencies.
CLAS – Culturally and Linguistically Appropriate Services were developed to advance health equity, reduce health care disparities, and improve quality of care by responding and respecting a person’s culture and language preferences.
CMCS – Center for Medicaid and CHIP Services serves as a CMS’ focal point that formulates, coordinates, and implements all national program policies and operations as it relates to Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP).
CMMI – Center for Medicare and Medicaid Innovation research information on new care models that enhance the quality of care and looks for ways to reduce costs through improvements to better serve Medicare and Medicaid members.
CMS – Centers for Medicare and Medicaid Services is a federal organization that provides health coverage to millions of people. Programs under CMS include Medicare, Medicaid, CHIP, and the Health Insurance Marketplace.
CORE – Community Oriented Recovery and Empowerment is a mobile, person-centered behavioral health assistance to those with a serious mental illness and/or substance use disorder. This program provides services in-home services or within the community as needed.
COTI – Centers of Treatment Innovation are OASAS-certified providers that help those struggling with a substance use disorder by providing mental health assessments, diagnoses, and medication management in coordination with a treatment plan.
CPE – Certified Public Expenditures is a methodology that gives NYS the ability to request additional funding for School Supportive Health Services Program (SSHSP) costs that are not fully covered by Medicaid.
CPST – Community Psychiatric Support Treatment are solution-focused interventions that help the individual achieve their goals in a person-centered manner.
CPT – Career Pathway Training is a program that can be used to build upon or enhance provider skills.
CSEA – Civil Service Employee Association is a union in New York State that works towards improving the work environments for state, county, and municipal employees.
D
DANY – Doctors Across New York is a state funded initiative that trains and places physicians in underserved communities.
DMCP – Division of Managed Care Policy is responsible for coordinating efforts to improve quality and regulatory oversight of managed care plans.
DSHP – Designated State Health Programs are not normally eligible for matching federal funds. However, under the 1115 Partnership Waiver, Center for Medicare and Medicaid Services (CMS) has the authority to match funding for state health programs in which CMS recognizes as providing a vital service to Medicaid members.
DSRIP – Delivery System Reform Incentive Payment was part of New York’s Medicaid Redesign Team (MRT) Waiver Amendment in 2014. DSRIP’s purpose was to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goals of stabilizing the safety-net system and reducing avoidable hospital use by 25% over a 5-year period.
DY – Demonstration Year is a period of time that covers one full year in which the New York State Health Equity Waiver (NYSHER) program will run.
Demonstration Year 0 – January 9, 2024 to March 31, 2024
Demonstration Year 1 – April 1, 2024 to March 31, 2025
Demonstration Year 2 – April 1, 2025 to March 31, 2026
Demonstration Year 3 – April 1, 2026 to March 31, 2027
E
EHR – Electronic Health Record or electronic medical record (EMR) is the means by which patient health information is stored and shared digitally.
EIN – Employer Identification Number is used to identify a business entity.
EISEP – Expanded In-Home Services for the Elderly are non-medical services for those aged 60 and older. These services include housekeeping, personal care, case management, respite, and emergency response devices.
EPIC – Elderly Pharmaceutical Insurance Coverage is a NYS Department of Health Program that helps those 65 years and older supplement their out-of-pocket Medicare Part D medication plan costs.
EPSDT – Early and Periodic Screening, Diagnostic, and Treatment provides preventative health care (mental, dental, preventative, developmental, and specialty) for children under 21 years old that are Medicaid members.
EQRO – External Quality Review Organization is an independent organization that evaluates aggregate information on healthcare services provided by managed care health plans.
ESHI – Employer Sponsored Health Insurance are plans offered by an organization to their employees as a benefit of employment.
EVV – Electronic Visit Verification a system such as telephonic, mobile, and web-based that verifies the occurrence of a home or community-based service visit. It identifies the start and end time of the service to ensure the service expected is provided.
F
FAFSA – Free Application for Federal Student Aid a no-cost form that anyone can use to apply for federal, state, and school financial aid programs. These include grants, scholarships, loans, and work-study funds.
FFP – Federal Financial Participation is the portion of Medicaid health program expenditures that are paid by a Federal Government.
FFS – Fee-For-Service is a system where payment is made is for a specific service provided and is volume based, regardless of health outcomes.
FFT – Functional Family Therapy is an intensive therapeutic model that provides family counseling in the home to address behaviors such as curfew violations, absenteeism, running away, etc.
FHIR – Federal Medical Assistance Percentage is a formula that accounts for the average per capita income for each state relative to the national average.
FMR – Fair Market Rent is determined by HUD and used to determine payments for housing assistance programs.
F-SHRP – Federal-State Health Reform Partnership are jointly funded programs by the state and federal government. These programs follow federal requirements; however, they are administered by the state.
FST – Family Support and Training is a person-centered, trauma-informed approach that offers emotional support and skill building to engage and support active participation of the family.
H
HARP – Health and Recovery Plans are Medicaid managed care plans that manage physical, mental, and substance use disorder services for adults and with significant behavioral health needs.
HCBS – Home and Community Based Services help individuals gain independence through learning/gaining life and social skills, and by providing education and employment supports.
HCPCS – Healthcare Common Procedure Coding System are standardized codes that are used to process health insurance claims. These codes represent medical procedures, supplies, services, etc.
HERO – Health Equity Regional Organization designated by NYS, the HERO will function as the central hub for developing and implementing health equity improvement initiatives statewide.
HH – Health Home is a management service that involves all of the individual’s caregivers, allowing them to communicate with each other so the individual’s health is viewed holistically. The care manager oversees the individual’s overall health to assure the individual is receiving everything they need. It is not a physical place.
HIE – Health Information Exchanges allows (with consent) health care providers, pharmacists, etc, to access a patient’s medical information electronically.
HIT – Health Information Technology is the process of storing and exchanging health information electronically.
HIV SNP – HIV Special Needs Plans is a health care plan for those on Medicaid living with HIV/AIDS or are homeless or transgender.
HL7 – Health Level 7 are global standards for the transfer of clinical and administrative health information between systems to help improve health outcomes and system performance.
HMH – Hospital Medical Home was a Partnership Plan CMS 1115 Waiver with New York State where hospitals transformed their primary care training sites into Patient-Centered Medical Homes (PCMHs) Level 2 or 3.
HRSA – Health Resources and Services Administration is an agency of the U.S. Department of Health and Human Services (HHS) and is the primary federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable. HRSA’s grantees provide health care to uninsured people, people living with HIV/AIDS, and pregnant women, mothers, and children. HRSA also supports the training of health professionals, the distribution of providers to areas where they are needed most, and improvements in health care delivery.
HRSN – Health Related Social Needs are the social and economic factors (e.g., food, housing, employment, education, transportation) that affect a person’s ability to maintain or improve their health and well-being.
HUD – Housing and Urban Development manages programs that work towards ensuring there are fair and equal housing opportunities for everyone.
HWB – Health Care Workforce Bonus is a program that allocates funding to pay bonuses to attract and retain certain frontline healthcare workers.
I
IAAF – Interim Access Assurance Fund assists safety-net hospitals that are in financial distress sustain critical health care services.
IAP – Innovation Accelerator Program to improve the health and health care of Medicaid members while reducing costs through the support of delivery system reform.
ICAN – Independent Consumer Advocacy Network assists New York Medicaid members who need long-term care and/or behavioral health services enroll in plans that cover those services.
ICF – Intermediate Care Facilities are places that offer long-term care to its residents. Care can include nursing or supportive care.
ICP – Indigent Care Pool provides funds to help hospitals cover the cost of care for low-income individuals.
IDGS – Individual Directed Goods and Services allow individuals who self-direct to purchase goods and services they need. These are services, equipment, or supplies that are not provided through OPWDD’s HCBS Waiver or through the Medicaid state plan.
IGT – Intergovernmental Transfers is a method where local government and public hospitals can transfer funds to the Agency for Health Care Administration to fund the Medicaid program.
IID – Individuals with Intellectual Disabilities is someone that may still live independently but have limitations on their mental abilities that affect learning, intelligence, and everyday life skills.
ILF – Independent Living Centers teach those with disabilities the skills needed to live independently. They also provide counseling, support groups, housing assistance, and referrals to other services.
IMD – Institute for Mental Diseases are places that provide a diagnosis, treatment, or care for those with a mental disease.
IRS – Internal Revenue Service enforces the US federal tax laws.
ISP – Individual Service Plan is a plan that is developed for a person with developmental disabilities that outlines the services needed to meet their life goals and their support needs.
L
LDSS – Local Department of Social Services are county departments that provide a variety of social services and assistance programs for community members that meet certain eligibility criteria.
LOC – Level of Care within the healthcare system depends on the complexity, the conditions a provider treats, and their specialties. For example, the primary level of care includes primary care providers and secondary care includes those providers that specialize in an area such as cardiologist and dermatologists.
LOCADTR – Level of Care for Alcohol and Drug Treatment Referral is a web-based tool that helps determine appropriate levels of care for those with a substance use disorder. This tool is used as a referral resource for providers, Medicaid Managed Care plans, and other referral sources.
LOI – Letter of Intent are nonbinding documents that outline and establish interest in participating in or working with an organization or person.
LTC – Long Term Care includes a variety of services that are designed to support the health and personal needs of those individuals who can longer do everyday activities on their own.
LTHHHCP – Long Term Health Home Care Program that provides nursing, medical, and rehabilitative care to those individuals who are eligible to be placed in a nursing home but choose to receive care/services at home.
LTNHS – Long Term Nursing Home Stays include medical and non-medical care for those that cannot perform daily activities on their own.
LTSS – Long Term Services and Supports are paid and unpaid (care provided by family or friends) medical and personal care such as eating, bathing, dressing, meal prep, or medication management which are provided over a short or long period of time.
M
MAGI – Modified Adjusted Gross Income is the adjusted gross income of a person after taking into account allowable deductions and tax penalties. MAGI is used to determine child Tax Credit, establish eligibility for Medicaid coverage, or used to determine eligibility for benefits such as the student loan interest deduction.
MAP – Medical Assistance Payments are for eligible individuals to use to help cover medical costs.
MAT – Medication Assisted Treatment uses medication in conjunction with counseling and behavioral therapy to help treat substance use disorders.
MBES – Medicaid Budget and Expenditure System is a reporting mechanism that Medicaid and CHIP agencies use to report budgeted and actual expenditure.
MCO – Managed Care Organizations are health care companies or health plans that focus on managed care as a model to keep quality of care high while limiting costs.
MDFT – Multidimensional Family Therapy focuses on the needs of adolescents and young adults that have a substance use disorder, mental health concern, or emotional concerns. MDFT includes and provides support to parents, families, and community organizations (e.g., schools) to reduce youth substance use, improve school attendance and academic achievement, stabilize mental health concerns, and teach coping and problem-solving skills.
MEG – Medicaid Expenditure Groups are categories of Medicaid or demonstration expenditures that are used to monitor and track expenditures under the demonstration.
MLR – Medicaid Loss Ratio are used to monitor growth in Medicaid spending.
MLTC – Managed Long-Term Care provides services to those who are chronically ill or have a disability that need long-term care services such as home care or adult day care. MLTC helps those stay in their homes and in their communities.
MLTSS – Managed Long Term Services and Supports is the delivery of long-term services and supports that are provided by managed care plans.
MMIS – Medicaid Management Information System was designed to monitor and track administrative program and cost control, member and provider inquiries and services, and reporting for planning and control.
MMMC – Mainstream Medicaid Managed Care Plan is a health insurance plan that most people with Medicaid in NYS will have.
MNIL – Medically Needy Income Level is an income level that is 138% of the Federal Poverty Level or equal to about $18,700 annually for a household of one.
MOE – Maintenance of Effort is a requirement that many federal funded grant programs have where recipients demonstrate that the level of local funding for that program remains consistent each year.
MRT – Medicaid Redesign Team in NYS created over 200 initiatives that were designed to implement programmatic changes to how health care is provided, reimbursed, and managed.
MST – Multi-Systemic Therapy is a treatment program designed to help troubled youth with serious criminal offenses and who may also have a substance use disorder.
N
NANY – Nurses Across New York is a program designed to recruit and train Registered Nurses (RN) and Licensed Practical Nurses (LPN) across a variety of settings and encourage them to practice in underserved communities.
NEMT – Non-Emergency Medical Transportation helps Medicaid members get to and from medical or dental appointments.
NF – Nursing Facilities is a place that provides care to elderly or disabled people. These can be nursing homes, skilled nursing facilities, or long-term care facilities.
NHTD (P) – Nursing Home Transition and Diversion (Program) assists Medicaid-eligible seniors and individuals with physical disabilities receive needed services to help them stay and live in a community setting vs a nursing home or other institution.
NOFO – Notice of Funding Opportunity is an announcement that invites grant award applications to be submitted for consideration.
NQF – National Quality Forum is a not-for-profit organization that supports the improvement of healthcare outcomes, safety, equity, and cost. They are a membership-based organization.
NWD – No Wrong Door is an initiative that provides a roadmap for developing a single access point for long-term services, supports, and benefits.
NYeC – New York eHealth Collaborative works to connect and integrate health information exchange (HIE) statewide to improve health outcomes.
NYHER – New York Health Equity Reform is a 1115 Medicaid Demonstration waiver program approved by CMS that aims to improve health outcomes and address health disparities throughout NYS.
O
OASAS – Office of Addiction Services and Supports is a state agency that oversees and monitors a network of prevention, treatment, and recovery providers. Also provides credentialing training and workforce development opportunities and directly operates 12 addiction treatment centers.
OCFS – Office of Children and Family Services promotes the safety and well-being of children, families, and communities through funding and supporting services, and enforcing policies.
OHIP – Office of Health Insurance Programs monitors and evaluates NYS health insurance plans and confidential data to ensure the privacy and protection of that sensitive information.
OLP – Other Licensed Practitioner is a licensed individual or someone that is certified under state law to provide medical or behavioral services and practices within the scope of their licensure.
OMH – Office of Mental Health regulates and oversees the mental health programs operated by local governments and non-profit organizations. OMH also operates psychiatric centers across NYS.
OPWDD – Office for People with Developmental Disabilities coordinates the services and supports for those with developmental disabilities including intellectual disabilities, autism, Down syndrome, cerebral palsy, ad other neurological disabilities.
OUD – Opioid Use Disorder is a chronic disorder with a pattern of opioid use that leads to potential serious consequences including disability, relapses, and death.
P
P4P – Pay for Performance is a payment model that rewards providers for meeting certain pre-established performance targets or measures for quality and efficiency.
PACE – Program of All-Inclusive Care for the Elderly is a program that provides medical and social care services to targeted frail, elderly individuals, many of whom are dual eligible for Medicaid and Medicare.
PCCM – Primary Care Case Management is where the primary care provider approves and monitors the care of the Medicaid member usually for a small case management fee on top of the fee-for-service reimbursement for treatment.
PCMH – Patient Centered Medical Home is a model of care where the patient is at the center and forefront of care. This model supports stronger relationship building between the provider team and the patient.
PCP – Primary Care Providers are health care practitioners that see individuals with common medical concerns. The Primary Care Provider is usually involved in the care of the patient over a long period of time seeing at least once a year for an annual well visit.
PCS – Primary Care Services include annual well visits/physicals, immunizations, treatment of acute illness and injuries, management of chronic illness, etc.
PDMP – Prescription Drug Monitoring Program is a database that tracks the distribution of prescriptions and controlled substances to help prevent drug abuse and protect public health and safety.
PHE – Public Health Emergency is an event (natural or manmade) that creates a health risk to the public.
PHL – Public Health Law focuses on the legal practice and advocacy of issues involving legal authorities and duties.
PIHP – Prepaid Inpatient Health Plan an entity that provides medical services to members and is responsible for setting up inpatient hospital care under a contract with a state Medicaid agency that is based on prepaid capitation payments.
PMDA – Performance Metrics Database and Analytics helps provide oversight and the ability to monitor and evaluate 1115 Medicaid state demonstration waivers.
PMP – Prescription Monitoring Program is a system where providers can view dispensed controlled substance prescription history for their patients.
PMPM – Per Member Per Month a payment model where a fixed dollar amount is paid out per enrolled member each month.
PSR – Psychosocial Rehabilitation assists with improving the functional abilities of the person within settings where they work, live, learn, and socialize.
Q
QE – Qualified Entities provide care including treatment, training, education, care, or instruction to vulnerable populations.
R
RDN – Registered Dietician Nutritionist are food and nutrition experts that guide people on how to live healthy and active lives.
RHCF – Residential Health Care Facilities are small facilities that provide non-institutional home-based services to the elderly who don’t need 24-hour nursing care.
RHIO – Regional Health Information Organization is a local hub where electronic health information is stored. Within NYS there are eight RHIOs.
RRSY – Residential Rehabilitation Services for Youth are designed to support youth through different programs and services that build resilience and support recovery.
S
SAMHSA – Substance Abuse and Mental Health Services Administration under the US Department of Health and Human Services, SAMHSA supports programs that raise mental health awareness and reduce substance use through prevention and treatment programs.
SBIRT – Screening, Brief Intervention, and Referral to Treatment is a comprehensive and integrated approach to the delivery of early intervention and treatment services for individuals with a substance use disorder or those who are risk of developing these disorders.
SCN – Social Care Network in New York State are tasked with building regional networks of social care providers that will provide HRSN screenings and deliver social care services to Medicaid members.
SDOH – Social Determinants of Health are non-medical factors that affect a person’s health outcomes. These can include food security, income, education, employment/unemployment, housing, early childhood development, access to care, etc.
SDP – State Directed Payment is a way in which States may direct managed-care payments to providers. These payments must be within Federal parameters; however States can determine criteria for providers to receive directed payments.
SHIN-NY – Statewide Health Information Network of New York connects healthcare professionals statewide through the exchange of secure health information.
SMA – State Medicaid Agency is the agency within a state that is responsible for administering the Medicaid program in that state.
SMDL – State Medicaid Director Letter often provides further communication and clarity regarding regulatory policies.
SMI – Serious Mental Illness is any mental health condition that including psychotic disorders, bipolar disorder, major depression with psychotic symptoms, anxiety or eating disorders. These are long-term conditions that often seriously affect life activities including day-to-day.
SNAP – Supplemental Nutrition Assistance Program is one of the largest nutrition assistance programs in the US that provides food benefits to low-income individuals and families.
SNP – Special Needs Plan is a tailored program that provides benefits and services to individuals with specific conditions, have certain health care needs, or have Medicaid.
SPA – State Plan Amendments are changes or proposed program changes/corrections to the original State Plan. These are reviewed and approved by CMS.
SSI – Supplemental Security Income are benefits paid monthly to those with limited income/ resources that are 65 years or older, blind, or have a qualifying disability.
STC – Special Terms and Conditions describe the general rules and requirements of the NYSHER waiver.
SUD – Substance Use Disorder is a condition where there is uncontrolled use of a harmful substance such as alcohol or psychoactive substances to the point that it can impair the individuals ability to function in their day-to-day life.
T
TANF – Temporary Assistance for Needy Families is a program that provides financial assistance payments, as well as a variety of services, to low-income families with children.
TAP – Tuition Assistance Program helps eligible individuals pay tuition as state approved educational institutions.
TBI (P) – Traumatic Brain Injury (Program) is a program designed to support and provide services to those who have suffered a TBI enabling them to live in their homes.
TCS – Transactions and Code Sets are standardized rules around the electronic exchange of health care information that can be used to identify a person.
V
VAPAP – Vital Access Provider Assurance Program provides funding to financially distressed providers with the purpose of helping them redesign their healthcare systems in the hopes of becoming financially stable.
VBP – Value Based Payments is a model that rewards quality outcomes and improved health versus paying for a specific service performed.
VFCA – Voluntary Foster Care Agency provides care for children and youth under 21 years of age. VFCA also provides limited health-related services.
W
WIC – Women Infants and Children is a supplemental nutrition program that provides supplemental foods, health referrals, and nutritional education for women, infants, and children up to 5 years of age.
WIO – Workforce Investment Organization provides a variety of trainings that enable employees to specialize in particular services areas.