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CSRRC Home : glossary

Glossary

Glossary & Acronyms [ Glossary | Acronyms ]

Administrative Services Organization (ASO)

An organization retained to provide administrative services, such as utilization review, preauthorization of services, and payment of claims.

Augmentation grants

Grants to pay for additional services provided to clients who have needs that are in excess of those typically experienced.

Capitation payment

A payment for a defined range of services for a defined period of time that may vary with the characteristics of the client. Normally, the capitation payment is expressed as a set amount per member per month. These rates are normally not affected by the number or type of actual services provided to the client.

Case rates

Payment rates that are based on the characteristics of the client and cover all of a defined range of services for a defined period of time. These rates are normally not affected by the number or type of actual services provided to the client.

Commission

Community Services Reimbursement Rate Commission.

Consumer safety costs

The costs incurred by a provider for care that is provided to comply with any regulatory requirements in the staffing or manner of care provided, including: 24-hour overnight awake supervision; and other cost factors related to health and safety that are stated in the care plan required for an individual.

Co-payment

A portion of a bill that is the responsibility of the patient and that applies when certain services are rendered. The amount usually varies by the nature of the service and the amount of the bill. This payment supplements the payment that is made by a third-party payer.

Core Service Agency (CSA)

A county-level agency responsible for planning and monitoring services at the local level.

CPT-4 codes

Current Procedural Terminology, fourth edition. A standardized system for numerically encoding health care procedures.

Fee-for-service

A payment system in which payments are made for individual services provided using a preset fee schedule.

Fee Payment System

The principal payment system used by DDA. This is the successor to the DDA PPS.

Gray-area individuals

Individuals who are not eligible for Medicaid, but who are eligible for publicly subsidized services.

Health Care Access and Cost Commission (HCACC)

An independent State of Maryland commission responsible for, among other things, collecting and disseminating data on health practitioner payments.

Health Care Financing Administration (HCFA)

The Federal agency responsible for, among other responsibilities, administering the Medicare and Medicaid programs. Now renamed to Center for Medicare and Medicaid Services (CMS).

Health Services Cost Review Commission (HSCRC)

An independent State of Maryland commission responsible for setting the rates of the hospitals in Maryland.

Home- and community-based waiver

A waiver provided to the State by the Federal Government allowing the Medicaid program to pay for services in the patient's home or in the community, rather than requiring that the services be provided in an institutional setting.

Individual (or client) component

The portion of the payment rate that is based on the requirements of the individual client.

Maryland Health Care Commission

The State agency formed by the combination of the Health Care Access and Cost Commission and the Health Resources Planning Commission.

Medicaid

An alternative name for the Medical Assistance Program.

Medical Assistance Program

A State-run program that pays for health care and long-term care services to individuals who satisfy certain qualifying criteria, particularly including income limits. This program is jointly funded by the State and Federal Governments.

Medicare

A Federal program that pays for acute health care services, including but not limited to inpatient hospital, outpatient, and physician services, for elderly or disabled individuals.

Prospective Payment System (PPS)

A payment system in which the payment rate is established in advance of the provision of services and is not altered based on the actual costs incurred by the provider.

Provider

A community-based agency or program funded: by the Developmental Disabilities Administration to serve individuals with developmental disabilities; or by the Mental Hygiene Administration to serve individuals with mental disorders.

Provider component

The portion of the payment rate that is intended to pay for administrative services and overhead. Specifically, this portion of the payment covers administrative, capital, general, and transportation costs.

Rate

The reimbursement rate paid by the Department to a provider from State general funds, Maryland Medical Assistance Program funds, other State or federal funds, or a combination of those funds.

Section 1115 Waiver

A waiver of Medicaid regulations provided by the U.S. Department of Health and Human Services to a State allowing for a managed care program for all or part of the Medicaid beneficiary population.

Supported employment

The provision of services related to helping a client find work or retain employment.

Transition plan

A plan to alleviate the immediate impact of the change in the payment system by phasing in the impact over a period of time.

 

Acronyms

AGC&T

Administrative, General, Capital, and Transportation

ASO

Administrative Services Organization

CBH

Council for Behavioral Health (formerly MAPSS and MCCMHP)

CMS

Center for Medicare and Medicaid Services (formerly HCFA)

CPT-4

Current Procedural Terminology, fourth edition

CSA

Core Service Agency

CSRRC

Community Services Reimbursement Rate Commission

DDA

Developmental Disabilities Administration

DHMH

Department of Health and Mental Hygiene

DRG

Diagnosis-related Group

FPS

Fee Payment System

HCACC

Health Care Access and Cost Commission

HCFA

Health Care Financing Administration

HSCRC

Health Services Cost Review Commission

MACS

Maryland Association of Community Services

MAPSS

Maryland Association of Psychiatric Support Services

MCCMHP

Maryland Council of Community Mental Health Programs, Inc.

MHA

Mental Hygiene Administration

MHCC

Maryland Health Care Commission

MHP

Maryland Health Partners

OMHC

Outpatient Mental Health Clinic

PMHS

Public Mental Health System

PPS

Prospective Payment System

TAG

Technical Advisory Group