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Glossary and Acronym List

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A B C D E F G H I J K L M N O P Q R S T U V W X Y  Z

 

 

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300%ers -- Persons whose income is up to three times the SSI payment limit. This optional

eligibility category is eligible for Medicaid by virtue of need for long term care services.

 

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A

 

 

A & A -- Aid and Attendance (VA Benefit)

 

A/CSA -- Alcohol/Controlled Substance Abuse

 

AAA -- Area Agency on Aging

 

AABD -- Aid to the Aged, Blind, and Disabled (Federal Term)

 

AARP -- American Association of Retired Persons

 

AAS -- Aging and Adult Services

 

AASD -- Aging and Adult Services Division

 

AB -- Aid to the Blind

 

AB-T -- Aid to the Blind- Treatment

 

ACF -- Alternative Care Facility

 

ACSES -- Automated Child Support Enforcement System

 

Acute Care & EQRO -- Adult Care & External Quality Review Organization

 

ADA -- Americans with Disabilities Act

 

ADAD -- Alcohol and Drug Abuse Division

 

ADC -- Adult Day Care

 

ADL -- Activities of Daily Living

 

ADP -- Automated Data Processing

 

ADS -- Adult Day Services

 

Adult Foster Care (AFC) -- This is not a Medicaid program or service; however, many AFC eligible are also Medicaid eligible. This provides residential care with supervision for client medications, etc. While these services are not as extensive as those rendered in a nursing home, they do represent an important component of a "continuum" of long term care. It is funded through a 95% General Fund and a 5% local match.

 

AFDC-A -- Aid to Families with Dependent Children- Adults

 

AFDC-C -- Aid to Families with Dependent Children- Children

 

AFDC-FC -- Aid to Families with Dependent Children- Foster Care

 

AFDC-I -- Aid to Families with Dependent Children- Incapacitated Parent

 

AFDC-U -- Aid to Families with Dependent Children- Unemployed Father

 

AG -- Attorney General

 

AIDS -- Acquired Immune Deficiency Syndrome

 

ALJ -- Administrative Law Judge

 

Allowed Charge-- The Amount Medicare Will Consider for Payment for a Given Service or Supply

 

AMPS-- Automated Medicaid Payment System- Electronic Claims System

 

Ancillary Services-- Those Service and Supplies Provided to Patients on an As-Needed Basis

 

AND-SSI -- Aid to the Needy Disabled- SSI

 

ANSI -- American National Standards Institute

 

AOA -- Administration on Aging

 

AP -- Assistance Payments

 

AP-700 -- Financial and Medical Eligibility Reporting Form

 

APD -- Advance Planning Document

 

APPLS -- Automated Personnel Payroll Ledger

 

APS -- Adult Protective Services

 

ASA -- American Society of Aging

 

ASC -- Ambulatory Surgical Centers

 

AU -- Administrative Unit

 

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B

 

 

BBA -- Balanced Budget Amendment

 

BC/BS -- Blue Cross/Blue Shield of Colorado, Medicaid's former Fiscal Agent

 

BCA -- Baby Care Adults

 

BCC -- Baby Care Children

 

BC-KC -- Baby Care - Kids Care Program

 

BCR -- Birthing Cost Recovery

 

BENDEX -- Beneficiary Data Exchange

 

Beneficiary -- One Who is Entitled to Receive Benefits

 

Benefits -- The Scope of Services Available to Beneficiaries

 

BI -- Brain Injury

 

BIA -- Bureau of Indian Affairs

 

BIDS System -- Colorado procurement information system

 

BL -- Black Lung

 

BMS -- Bureau of Medical Services (Obsolete- Now MS)

 

BPR -- Business Process Reengineering

 

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C

 

 

CACTIS -- Colorado Automated Client Tracking Information System

 

CAFSS -- Colorado Automated Food Stamp System

 

CAHHA -- Colorado Association of Home Health Agencies

 

CAHPS -- Consumer Assessment of Health Care Study

 

CAHSA -- Colorado Association of Homes and Services for the Aging

 

CAP -- Colorado Admissions Program

 

CAPD -- Continuous Ambulatory Peritoneal Dialysis

 

CAPS -- County Automated Payment System

 

CARC -- Colorado Association for Retarded Children

 

Carve-Out -- A Benefit or Service that is not Included Under an Otherwise Global Services Agreement, Such As a Medicaid HMO Contract

 

Case Mix Demo -- Pilot Effort Directed by HCFA to Test & Prove CM Using the MDS & RUG 3 as the Case Mix Reimbursement System for Medicare SNF Patients. KS, MS, ME, TX, NY, SD are the Participating States

 

CAT Scans -- Computerized Axial Tomography

 

CBHP -- Children's Basic Health Plan

 

CBLTC -- Community Based Long Term Care

 

CBMS -- Colorado Benefits Management System

 

CBP -- Common Business Process

 

CBT -- Computer-Based Training

 

CCB -- Community Centered Board (for DD) or Change Control Board

 

CCHN -- Colorado Community Health Network (Assoc. of FQHCs)

 

CCI -- Colorado Counties, Inc.

 

CCOA -- Colorado Commission on Aging

 

CCPD -- Continuous Cycling Peritoneal Dialysis

 

CCR -- Code of Colorado Regulations

 

CCSO -- Colorado Congress of Senior Organization

 

CDAS -- Consumer Direct Attendant Support

 

CDBG -- Community Development of Social Services

 

CDF -- Colorado Drug Formulary

 

CDHCPF -- Colorado Department of Health Care Policy and Financing

 

CDHS -- Colorado Department of Human Services

 

CDOLE -- Colorado Department of Labor and Employment

 

CDOR -- Colorado Department of Revenue

 

CDPHE -- Colorado Department of Public Health and Environment

 

CDSS -- Colorado Department of Social Services or County Department of Social Services or County Department of Human Services

 

CEDARS -- Colorado Eligibility Disbursement and Reporting System

 

CFMC -- Colorado Foundation for Medical Care- HCPF's PRO Contractor

 

CFR -- Code of Federal Regulations

 

CGS -- Colorado Gerontological Society

 

CHAMPUS -- Civilian Health and Medical Program of the Uniformed Services

 

CHATS -- Child Care Automated Tracking System

 

CHFA -- Colorado Housing Finance Authority

 

Children's HCBS -- HCBS for children with physical disabilities

 

CHINS -- Children in Need of Supervision

 

CHP+ -- Children's Health Plan Plus

 

CICP -- Colorado Indigent Care Program

 

CIDS 2000 -- Client Information Data Subsystem for the 21st Century

 

CIN -- Colorado Information Network

 

CLASS I -- Refers to general nursing facilities

 

CLASS II/IV -- Refers to nursing facilities for physically and developmentally disabled individuals

 

CLASS IV Nursing Homes -- Regional Centers for persons with developmental disabilities (operated by CDHS)

 

CLEAR -- Colorado List of Emergency Assistance Recipients

 

CM -- Case Manager

 

CMA -- Case Management Agency

 

CMER -- Colorado Medicaid Eligibility Response

 

CMI -- Comparative Measure Index

 

CNS -- County Nursing Service

 

CO/EBTS -- Colorado Electronics Benefits Transfer Service

 

COBRA -- Consolidated Omnibus Budget Reconciliation Act of 1985

 

COFRS -- Colorado Financial Reporting System

 

COIN -- Client Oriented Information System (CDHS-HCPF eligibility database)

 

Co-Insurance -- The amount of the allowed charge the beneficiary is responsible for paying on assigned medicare beneficiaries

 

COLA -- Cost of Living Adjustment

 

COLO R/X -- Colorado Drug Formulary

 

Colorado Works -- Colorado's Welfare Reform Program (see: TANF)

 

Consultec -- Medicaid, CBHP, CICP, etc., fiscal agent beginning December 1st, 1998

 

CPAS -- Claims Processing Assessment System

 

CPT-6 -- Current Procedural Terminology (Physician Reimbursement Guide)

 

CQC -- County Quality Control

 

CRCP -- Central Registry for Child Protection

 

CRD -- Chronic Renal Disease

 

CRLS -- Colorado Rural Legal Services

 

CRSP -- Colorado Refugee Service Programs

 

CS -- Federal SSI-Colorado Supplement

 

CSBG -- Community Services Block Grant

 

CSE -- Child Support Enforcement

 

CSL -- Colorado Senior Lobby

 

CSPR -- Control System for Proposed Rules (State Regulations)

 

CSR -- Continued Stay Review

 

CSU -- Child Support Unit

 

CTRANS -- County Transportation Refers to Non-Emergency or Non-Wheel Chair Transportation Services

 

Customary Charge -- The most common charge by a provider for a particular service to the majority of patients

 

CW -- Child Welfare

 

CWEST -- Child Welfare Eligibility and Services Tracking System

 

CW-FC -- Child Welfare - Foster Care

 

CWS -- Division of Child Welfare Services

 

CY -- Calendar Year

 

CYF -- Children, Youth, and Families

 

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D

 

 

Day Program -- Part of the home and community based services for persons with developmental disabilities. This is the day program part of the waiver.

 

DC -- Day Care

 

DD -- Developmentally Disabled

 

DEFRA -- Deficit Reduction Act

 

DHMC -- Denver Health Medical Center

 

DHS -- Colorado Department of Human Services

 

DIH -- Department of Indian Health

 

DLE -- Colorado Department of Labor & Employment

 

DMA -- Division of Medical Assistance (obsolete now AAS)

 

DME/MED EQUIP. -- Durable Medical Equipment and Supplies

 

DORA -- Colorado Department of Regulatory Agencies

 

DPHE -- Colorado Department of Public Health and Environment

 

DRG -- Diagnosis Related Group

 

DSH -- Disproportionate Share Hospital

 

DSS -- Decision Support System

 

DYC -- Division of Youth Corrections

 

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E

 

 

EA -- Emergency Assistance

 

EBD -- Elderly, Blind, and Disabled

 

EBT/EFT -- Electronic Benefit Funds Transfer

 

EGHP -- Employer Group Health Plan

 

EID -- Employment Information Data

 

EIS/DSS -- Executive Information System/Decision Support System

 

EJB -- Enterprise Java Beans

 

Eligible -- This refers to one full time equivalent client for a defined period of time. Every person who is issued a MAC Is called an "eligible." It does not refer to the number of clients who actually use a medical service. When a MAC is issued, the computer system assigns a prescribed span of time for which the person is eligible. If eligibility is not renewed at the end of the span, eligibility lapses.

 

EMC -- Electronic Media Claim

 

EMS -- Eligibility Management Systems

 

EOMB -- Explanation of Medicare Benefits

 

EPM -- Enterprise Project Manager

 

EPSDT Dental -- Early and Periodic Screening, Diagnosis and Treatment (Preventive Health Care Program for Medicaid Clients Up to age 21)

 

EQRO -- External Quality Review Organization

 

ERS -- OYS Education Records System

 

ESC -- Employment Status Code

 

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F

 

 

F PLAN -- Family Planning refers to services which are paid through the family planning clinics for which an annual capitation is paid for all family planning services eligible for one year

 

FA -- Fiscal Agent (Blue Cross/Blue Shield of Colorado)- Medicaid's Fiscal Intermediary; operates the provider claim system and MMIS database

 

FAMIS -- Family Assistance Management Information Systems

 

FC -- Foster Care Children

 

FCS-100 -- Foster Care and Subsidized Adoption and Medicaid Eligibility Tracking

 

FDA -- Food and Drug Administration

 

FDDI -- Fiber Distributed Data Interface

 

FFP -- Federal Financial Participation

 

FFS -- Fee for Service (non-capitated health care payment system)

 

FFY -- Federal Fiscal Year

 

FGP -- Foster Grandparent Program

 

FI -- Fiscal Intermediary (Medicare)

 

FIPS PUB -- Federal Information Processing Standard Publication

 

Fiscal Intermediary -- An insurance company which manages medicare claims and provides audit-reimbursement services for HCFA to assure providers utilize program benefits appropriately

 

FLOOR -- Medicare statute for the minimum amount of time a claim must be held before payment/also minimum payment, etc.

 

FNS -- Food and Nutrition Services

 

FPL -- Federal Poverty Limit

 

FQHC/Rural Clinic -- Federally Qualified Health Clinic (or center )- health service facility for low income persons in a medically under served area

 

FR -- Federal Register (Publication of Federal Regulations)

 

FRV -- Fair Rental Value

 

FS -- Food Stamps

 

FSJS -- Food Stamp Job Search System

 

FSR -- Feasibility Study Report

 

FTE -- Full Time Equivalent

 

FY -- Fiscal Year (state)

 

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G

 

 

GA -- General Assistance

 

GB -- Giga Bytes

 

GGCC -- General Government Computer Center

 

GJTO -- Governor's Job Training Office

 

GSS -- (Colorado Department of) General Support Services

 

GUI -- Graphic User Interface

 

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H

 

 

HB -- House Bill (introduced to the Colorado House in the General Assembly/Legislature)

 

HB 97-1304, HB 97-1325 -- Authorizing legislation for the Children's Basic Health Plan (CBHP)

 

HCA -- Home Care Allowance

 

HCBS -- Home and Community Based Services

 

HCBS-BI -- Home and Community Based Services - Persons with brain injury

 

HCBS-CES -- Home and Community Based Services - Children's Extensive Support

 

HCBS-CM -- Home and Community Based Services for the Elderly, Blind, and Disabled Case Management

 

HCBS-CMW -- Home and Community Based Services - Children's Medical Waiver

 

HCBS-CS -- Home and Community Based Services for the Elderly, Blind, and Disabled Client Services

 

HCBS-DD -- Home and Community Based Services - Persons with Developmental Disabilities

 

HCBS-EBD -- Home and Community Based Services - Elderly, Blind, and Disabled

 

HCBS-MI -- Home and Community Based Services - Mentally Ill

 

HCBS-PLWA -- Home and Community Based Services - People Living with AIDS

 

HCBS-SLS -- Home and Community Based Services - Supported Living for persons with developmental disabilities

 

HCFA -- Federal Health Care Financing Administration

 

HCPCS -- HCFA Common Procedure Coding System (Outpatient)

 

HCPF Medicaid -- Colorado Department of Health Care Policy & Financing

 

Health Insurance Buy-In -- Premium and coinsurance/deductible payments for private health insurance policies for medicaid clients when it can be shown to be cost effective

 

HEDIS -- Healthcare Effectiveness Data and Information Set

 

HEWI -- Health, Environment, Welfare & Institutions

 

HH -- Home Health Care

 

HH# -- County Household Number

 

HHA -- Home Health Aide or Home Health Agency

 

HHS -- Health and Human Services Federal agency

 

HIBI -- Health Insurance Buy-In Program

 

HIM -- Health Insurance Manual

 

HIMS -- Health Information Management System

 

HIS -- Indian Health Services

 

HM -- Home Maker

 

HMO -- Health Maintenance Organization

 

Home Care Allowance -- This is not a Medicaid program or service; however, most Home Care Allowance eligible are also Medicaid eligible. Services are for persons residing in their own homes and include personal care and supportive services. While these services are not medical in nature, they do represent an important component of a "continuum" of long term care. It is funded through 95% General Fund and 5% Local Match

 

Home Mod -- Home Modification

 

HOSPICE -- Hospice

 

HRC -- Human Resources Committee

 

HSP -- Hospital Specific Portion

 

HTML -- Hyper Text Markup Language

 

HTTP -- Hyper Text Transfer Protocol

 

HUD -- Housing and Urban Development

 

HW -- Hardware

 

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I

 

 

IADL -- Independent Activity of Daily Living

 

IAPD -- Implementation Advance Planning Document

 

ICD-9-CM -- International Classification of Diseases, version 9, Clinical Modification

 

ICF -- Intermediate Care Facility

 

ICF-MR -- Intermediate Care Facility for the Mentally Retarded

 

ICN -- Internal Control Number

 

IEVS -- Income Eligibility Verification System

 

IFF -- Intrastate Funding (Allocation) Formula for QAA Funds

 

IM -- Income Maintenance

 

IMAP -- Information Management Annual Plan

 

IMC -- Information Management Commission

 

Inpatient -- Inpatient Hospital Care

 

Intermediary (F.I.) -- An independent insurance company contracted by HCFA to administer payments for Medicare

 

IPV -- Intentional Program Violation

 

IRFP -- Implementation Request for Proposal

 

ISP -- Internet Service Provider

 

IT -- Information Technology

 

ITS --I nformation Technology Services

 

IV-A -- Title IV-A, Social Security Act Federal AFDC regulations

 

IV-D -- Title IV-D, Social Security Act Federal Child Support Enforcement Program regulations

 

IV-E -- Title IV-E, Social Security Act, Generally refers to children eligible for TANF payments but the child is in foster care

 

IVES --I ncome Eligibility Verification System

 

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J

 

 

JAD -- Joint Application Development

 

JAVA -- A programming language

 

JBC -- Joint Budget Committee

 

JDBC -- Java Database Connectivity

 

JHAC -- Joint Commission of the Accreditation of Hospitals

 

JOBS -- Job Opportunity Basic Skills (Federal employment program)

 

JTPA -- Jobs Training Partnership Act

 

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L

 

 

Lab/X-ray -- Laboratory and Radiology Services

 

LAC -- Lifetime Authorization Cards

 

LAN -- Local Area Network

 

LEAP -- Low-income Energy Assistance Program

 

LGHP -- Large Group Health Plan

 

LOC -- Level of Care or Line of Code

 

LOP -- Local Operational Plan

 

LOS -- Length of Stay

 

LPN -- Licensed Practical Nurse

 

LSC -- Legal Services Corporation

 

LSD -- Legal Services Developer

 

LTC -- Long Term Care

 

LTC-101 -- Long Term Care Assessment Form

 

LTC-102 -- Monthly HCBS Non-Diversion/Termination Report Form

 

LTC-103 -- HCBS Case Plan Form

 

LTC-104 -- HCBS Case Plan Revision Form

 

LTC-105 -- HCBS Prior Approval and Cost Containment Form

 

LTC-106A -- Client Payment Form for HCBS- 300% Non ACF Clients

 

LTC-106B -- Client Payment Form for HCBS- All ACF Clients

 

LTC-107 -- HCBS Notice of Service Status/Eligibility Form

 

LTC-108 -- HCBS Statement of Services (Claim Form)

 

LTC-109 -- HCBS Form for Application of Individual Providers

 

LTC-110 -- HCBS Form for Monthly Listing of New Individual Providers, Re-certifications, De-certification

 

LTC-111 -- HCBS Complaint Information Form

 

LTCO -- Long Term Care Ombudsman

 

LVN -- Licensed Vocational Nurse

 

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M

 

 

MA -- Medical Assistance

 

MAC -- (Mutually exclusive meanings depending upon context):

 

  • Medical Authorization Card (Client's Medicaid Card)
  • Medical Assistance Advisory Council
  • Maximum Allowable Cost

 

MAPI -- Messaging Application Program Interface

 

MB -- Mega Bytes - a measure of computer memory or file size

 

MBE/WBE -- Minority-owned Business Enterprise/Woman-owned Business Enterprise

 

MC -- Medicaid

 

MCO -- Managed Care Organization

 

MCPI -- Medical Consumer Price Index

 

MCR or M18 -- Medicare

 

MDS 2.0 -- Minimum Data Set for resident assessment

 

MDS Automation Demonstration -- Pilot effort directed by HCFA to test & prove automated MDS submission by nursing facilities

 

MDS+ -- The NF Demonstration version of the MDS, Main, Mississippi & South Dakota us 12/1/90 b version. It meets the federally mandated requirements for primary resident care screening & assessment.

 

Medicare -- That portion of the Social Security Act which provides health care benefits to citizens over age 65 or under age 65 who are permanently disabled or suffering from chronic renal failure

 

Medicare Part A -- That part of medicare law providing for in-patient hospitalization, SNF care, NH benefits, & home health services to senior citizens

 

Medicare Part B -- A supplementary program to Part A providing for physicians' services, outpatient hospital services, & other supplies. Waivers were granted in 1996 to enable use of RUGs 3 for routine costs.

 

Medicare/TPL -- Medicare/Third Party Liability

 

Mental Health -- This refers to the mental health care provided through the community

 

MHASA -- Mental Health Assessment & Services Agency

 

MI -- Medically Indigent

 

MK or M19 -- Medicaid

 

MMIS -- Medicaid Management Information System

 

MMQ -- A Case Mix RAI developed by Hill haven & used by MA

 

MOE -- Maintenance of Effort - This is a federal mandate requiring states (and, where applicable counties) to spend at least 80% of the funding amounts expended in base year 1993. If the state pays 80% of the base year expenditures, then even if welfare rolls escalate in future years, the federal government will continue to supply its share of funds for the higher costs. This is intended to assure that states expend a proper amount of state funds relative to federal funds.

 

MOU -- Memorandum of Understanding

 

MOW -- Meals on Wheels

 

MR -- Mentally Retarded

 

MRI -- Magnetic Resonance Imaging

 

MS -- Medical Services

 

MSA -- Metro Statistical Area

 

MSP -- Medicare Secondary Payer

 

MSR -- Monthly Status Report

 

MSW -- Master's of Social Work or Medical Social Work

 

MTBD -- Mean Time Between Defects

 

MTBF -- Mean Time Between Failures

 

MTS -- Medicare Transaction System

 

MTTR -- Mean Time To Restore

 

MVS -- IBM Mainframe Operating System

 

MVS -- Multiple Virtual Storage

 

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N

 

 

NAAAA -- National Association of Area Agencies on Aging

 

NASUA -- National Association of State Units on Aging

 

NASW -- National Association of Social Workers

 

NCANDS -- National Child Abuse and Neglect Data Systems

 

NCOA -- National Council on Aging

 

NCQA -- National Commission on Quality Assurance

 

NCSC -- National Council of Senior Citizens

 

ND -- Non-Diversion

 

NDS -- Net ware Directory Services

 

NF -- Nursing Facility

 

NH -- Nursing Home

 

NON-PPS -- Non-Prospective Payment System

 

NPE -- Nutrition Program for the Elderly

 

NRST -- Non-Resident Specific (Nursing or Therapy Staff Times)

 

NRTA -- National Retired Teachers Association

 

NT Windows -- Windows New Technology Operating System

 

NTS -- Nonresident Tracking System

 

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O

 

 

OAA -- Older Americans Act

 

OAP/A -- Old Age Pension/65 years or older

 

OAP/B -- Old Age Pension/60 to 64 years

 

OAP/SO -- Old Age Pension- State Only health and medical benefits

 

OASDI -- Old Age Survivors Disability Insurance

 

OAVP -- Older American Volunteer Programs

 

OBRA -- Omnibus Budget Reconciliation Act

 

OCA -- Older Coloradans Act

 

OCYF -- Office of Children, Youth, and Families

 

ODBC -- Open Database Connectivity

 

OIG -- Office of Inspector General

 

OIT -- Office of Information Technology

 

OLTC -- Options for Long Term Care

 

OLTP -- Online Transaction Processing

 

OMB -- Office of Management and Budget

 

OP -- Outpatient

 

Option/Mandate -- Certain Medicaid services are mandated by federal law as a cost of participating in the federal Medicaid program and certain others are optional for the states.

 

Option/Mandate -- Certain Medicaid services are mandated by federal law as a cost of participating in the federal Medicaid program and certain others are optional for the state

 

ORB -- Object Request Broker

 

ORD -- Office of Research and Demonstrations

 

OSPB -- Office of State Planning and Budget (Governor's Office)

 

OT/PT/ST -- Occupational Therapy/Physical Therapy/ Speech Therapy

 

OTC -- Over the Counter Drugs

 

OUT -- Outcome Tracking Unit

 

Outpatient -- Outpatient Hospital Services includes all hospital-based outpatient care ranging from emergency room to hospital based care

 

Over 65 -- Inpatient Psychiatric Hospital Care for Persons over age 65. State owned and operated hospital care.

 

OYS -- Office of Youth Services

 

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P

 

 

PA -- Public Assistance

 

PA-1 -- Program Area One- Adult Self Sufficiency, Social Services Block Grant, Social Security Act

 

PA-2 -- Program Area 2- Adult Protective Services, Social Services Block Grant, Social Security Act

 

PAC -- Political Action Committee, also Policy Advisory Committee to CDSS

 

PACE -- Programs of All Inclusive Care for the Elderly

 

PAPD -- Planning Advance Planning Document

 

PAR -- Prior Authorization Review

 

PASARR -- Pre Admission Screening and Annual Resident Reviews

 

PC -- Personal Care

 

PCBH -- Personal Care Boarding Home

 

PCD -- Project Control Document

 

PCP/PCPP -- Primary Care Physician/Primary Care Physician Program

 

PDCS -- Prescription Drug Card System

 

PDN -- Private Duty Nursing

 

PE -- Presumptive Eligibility

 

PERA -- Public Employees - Retirement Association

 

PETI -- Post Eligibility Treatment of Income

 

PHN -- Public Health Nurse

 

PHP -- Prepaid Health Plan

 

Physician -- Physician's services are those ranging from family practice to specialty care.

 

PI -- Program Integrity

 

PIN -- Personal Identification Number

 

PLWA -- People Living With AIDS

 

PMR -- Planning and Management Region

 

PN -- Personal Needs

 

POC -- Plan of Care

 

POPs -- Points of Presence

 

POS -- Point of Service- child based HMO or Point of Sale

 

PPD -- Per Patient Day

 

PPHP -- Pre Paid Health Plan

 

PPO -- Preferred Provider Organization

 

PPS -- Prospective Payment System

 

PPV -- Pneumococcal Pneumonia Vaccine

 

Prescription Drug -- Includes payment for all drugs provided through Medicaid including those dispensed in nursing home, but excluding those which are dispensed in the inpatient hospital setting

 

PRO -- Peer Review Organization

 

PROC -- Procedure

 

PRO-DUR -- Prospective Drug Utilization Review

 

PSA -- Planning and Service Area

 

PSRO -- Professional Standards Review Organization

 

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Q

 

 

QA -- Quality Assurance

 

QC/QA/ME -- Quality Control/Quality Assurance/Management Evaluation

 

QDWI -- Qualified Disabled & Working Individuals

 

QMB -- Qualified Medicare Beneficiary

 

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R

 

 

R/R/R -- Re-determination/Re-certification/Reassessment

 

RA -- Remittance Advice

 

RAD -- Rapid Application Development

 

RAI -- Resident Assessment Instrument

 

RAPs -- Resident Assessment Protocols

 

RAS -- Remote Access Services

 

RDBMS -- Relational Database Management System

 

Rebate- Prescription Drugs -- Medicaid prescription drug optional benefit. In an effort to offset the additional costs related to the items above, manufacturers rebate Medicaid drug expenses for certain items. The rebates are not accounted for in MMIS data and are handled manually through accounting transactions.

 

Residential Program -- Part of the Home and Community Based Services for the Developmentally Disabled, is the residential care provided for under the waiver.

 

RETRO-DUR -- Retrospective Drug Utilization Review

 

RFP -- Request for Proposal

 

RHC -- Rural Health Clinic

 

RN -- Registered Nurse

 

RO -- Regional Office (HCFA)

 

ROI -- Return on Investment

 

RPC -- Remote Procedure Call

 

RRB -- Railroad Retirement Benefits

 

RSDI -- Retirement, Survivors, Disability Insurance

 

RST -- Resident Specific- Nursing or Therapy Staff Times

 

RSVP -- Retired Senior Volunteer Program

 

RTC -- Residential Treatment Center (Children with behavioral problems)

 

RTD -- Resubmission Turn-Around Document

 

RTP -- Return to Provider Form Used by BC/BS

 

RUGs -- Resource Utilization Groupings

 

RUGs III -- The most recent version of RUGs

 

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S

 

 

SACWIS -- Statewide Automated Child Welfare Subsystems

 

SAM -- Employment First System

 

SB -- Senate Bill (introduced to the Senate in the Colorado General Assembly/Legislature)

 

SB 5 -- Medicaid Managed Care legislation

 

SB 138 -- Obsolete term for the HCBS-EBD Program

 

SB 38 -- Pilot Program that Preceded HCBS

 

SB 42 -- Social Security Legislation directing Case Mix

 

SBSS -- State Board of Social Services

 

SCP -- Senior Companion Program

 

SCSEP -- Senior Community Service Employment Program

 

SCW I, II, III -- Social Case Worker under the Merit System

 

Section S -- Only MDS section allowed for unique state use & change

 

Section T -- Record Nursing Therapy

 

Section U -- Records Medication Information

 

SEP -- Single Entry Point

 

SHEA -- State Health Expenditure Account

 

SIDMOD -- State Identification Module

 

SISC -- SSI Status Code

 

SLMB -- Special Low-Income Medicare Beneficiaries

 

SLP -- Service Level Plan

 

SMIB -- Supplementary Medical Insurance Benefits

 

SMSA -- Standard Metropolitan Statistical Area

 

SN -- Skilled Nursing

 

SNA -- Systems Network Architecture

 

SNF -- Skilled Nursing Facility

 

SOW -- Statement of Work

 

SPA -- Single Purpose Application

 

SPSS -- Statistical Package for the Social Sciences

 

SQL -- Structured Query Language

 

SS-4 -- County Department of Social Services Form to Notify Clients of Service Status/Eligibility

 

SS-6 -- County Department of Social Services Case Plan Form

 

SSA -- Social Security Administration

 

SSBG -- Social Services Block Grant

 

SSCN -- Social Security Claim Number

 

SSI -- Supplemental Security Income

 

SSI-CS -- Supplemental Security Income- Colorado Supplement (OAP)

 

SSL -- Secure Socket Layer

 

SSN -- Social Security Number

 

SSO -- Single Sign-On

 

SSO -- Social Security Office

 

SSS -- Social Services Syndrome

 

SSTABS -- Social Service Technical & Business Staffs (Association)

 

ST -- Speech Therapist or Therapy

 

ST. I.D. # -- State Identification Number (Medicaid #)

 

STAC -- Specialized Transportation Association of Colorado

 

STARS -- Services, Tracking, Analysis & Reporting System

 

STM -- Staff Time Measurement (SNF)

 

SUA -- State Unit on Aging

 

SURS -- Surveillance Utilization Review Subsystem

 

SW -- Software

 

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T

 

 

TANF -- Temporary Assistance to Needy Families

 

TCM-DD -- Targeted Case Management-Developmentally Disabled

 

TCP/IP -- Transmission Control Protocol/Internet Protocol

 

TILES -- A Case Mix RAI developed & discontinued by Texas

 

Title XIX -- Social Security Act- Medicaid

 

Title XVIII -- Social Security Act- Medicare

 

Title XX -- Refers to State Children's Health Insurance Plan

 

TP -- Transaction Processing

 

TPL -- Third Party Liability

 

TPR -- Third Party Recovery or Third Party Resources

 

Transportation -- Emergency Transportation

 

TRIGGERS -- MDS data which points to specific RAPS

 

TTS -- Title 4-E Tracking System

 

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U

 

 

UAT -- User Acceptance Test

 

UB92 -- Uniform Billing Form HCFA 1450

 

UCB -- Unemployment Compensation Benefits

 

ULTC-100 -- Uniform Long Term Care (client needs assessment tool form)

 

Under 21 Psych. -- Private Psychiatric Hospital Care for Persons under age 21

 

Undoc -- Undocumented Immigrants

 

Unknown -- Refers to appeal or adjustment activity which is not necessarily specific to one single claim/eligible or for a client who no longer has an active eligibility span on the recipient eligibility file in the MMIS.

 

UR -- Utilization Review of medical providers

 

URL -- Universal Resource Locator

 

USC -- United States Code

 

USD -- Unified Software Distribution

 

USDA -- United States Department of Agriculture

 

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V

 

 

VA -- Veterans Administration

 

VISTA -- Volunteers in Service to America

 

Vol 10 -- CDSS Staff Policy Manual for State Policy on Older Americans Act

 

Vol 7 -- CDSS Staff Policy Manual for Social Services

 

Vol 8 -- CDSS Staff Policy Manual for Medicaid

 

VR -- Vocational Rehabilitation

 

VRS -- Voice Response System

 

VSAM -- Virtual Sequential Access Method

 

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W

 

 

WAN -- Wide Area Network

 

WC -- Worker's Compensation

 

WIC -- Women, Infants, and Children

 

Wrap Around Services -- Medicaid services that are not covered by HMOs, but that are covered for Medicaid clients enrolled in HMOs by referral or direct access to fee-for service Medicaid Providers.

 

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X

 

 

XML -- Extensible Markup Language

 

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Y

 

 

Y2K -- Year 2000

 

YTD -- Year To Date

 

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