Community
Services
Reimbursement
Rate
Commission
An independent commission within DHMH:
The Maryland Department of Health and Mental Hygiene
Martin O'Malley,
Governor
Theodore N. Giovanis,
Chairman
Commissioners:
• Theodore N. Giovanis, FHFMA, M.B.A.
• Alan C. Lovell, Ph.D.
• Lori Somerville, B.S, M.S.
• Lynn Garrison, M.B.A.
• Jeff Richardson, M.B.A., LCSW-c
• Jeanette M. Martin, BS, MS
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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. |
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 |
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