Health care policy exam 1
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Children's Health Insurance Program (CHIP)
- started in 1997.
- federal-state program that provides health care for low-income children NOT eligible for Medicaid.
- Fed match states' spending on CHIP but funds are capped.
Department of Health and human services (DHHS)
US gov't principal agency for protecting health and providing human services to all Americans
health insurace offered to employees by the workplace
- enacted in 1965 under title 17 of social security act
- federal entitlement program for those 65 and older, people with permanent disabilities, etc.
- enacted in 1965 under title 19 of social security act
- federal entitlement program to certain categories of low-income Americans
- fills a key role in gaps of health insurance system.
- safety net for the uninsured
Patient protection and affordable care act (PPACA aka ACA aka Obama Care)
- enacted on March 23, 2010.
- expands coverage, individual mandate and health insurance exchanges, controls health care costs and imprves health care delivery system. o
Accountable Care organization (ACO)
- network of health care providers that band together to provide full continuum of health care services for patients
- network receives payment for all care provided and held accountable for quality/cost of care
- proposed pilot program in Medicare/Medicaid provide financial incentives to improve quality decrease cost by allowing sharing of savings
American recovery and reinvestment act (2009). aka the stimulus or the recovery act
economic stimulus package created in February 2009.intended to create jobs and promote investment/consumer spending during recession
fixed payment provided to a health provider from a managed care plan for the care of a patient, regardless of the type or number of services actually provided.
fixed amount that MUST be paid by a patient before health plan begin to cover other services
individual that is eligible for Medicare and someMedicaid benefits.
Electronic Health record (EHR)
a medical record in digital format
Federal medical assistance percentage (FMAP)
- statutory term for federal Medicaid matching rate
- i.e. share of the costs of Medicaid services/administration that the Fed bears.
- on average, Fed pays 57% of Medicaid costs
Health Maintenance Organization (HMO)
- type of managed care plan that offers prepaid comprehensive health service coverages, relying on its medical providers to minimize cost of providing
- HMOs contract with or directly employ participating health service providers.
- users must pay full cost of non-network providers
Managed Care Organization
- umbrella term. refers to a variety of health care products such as PPO, HMOs, and POS plans
- contract with limited set of health care providers, often called network.
- maintains control over how, where, when by whom, and in what quantity healthcare is delivered
health care costs NOT covered by insurance. does NOT include premium
Amount paid, often on monthly basis, for health insurance
non-specialty care provided by Dr, RNs, and others
people who are insured but face big costs/limits on benefits
Activities of Daily living (ADL)
tasks used to measure a person's functional status, including eating, bathing, dressing, etc.
a method of cost-sharing in health insurance plans in which the plan member is required to pay a defined percentage of medical costs AFTER premium is met
- any contribution consumers make towards cost of health care as defined by their health insurance.
- ex: co-pay, co-insurance, annual deductibles
a gap in prescription drug coverage under Medicare part D.
- primary: difference between current govt spending and and revenue
- total: spending plus interest payments on debt minus tax revenues
Fee for service (FFS)
- traditional method of paying for health care services based on actual care delivered.
- i.e. providers paid by each service they done
- health/social services for people with permanent disabilities or chronic illness.
- may be provided in residential facility, home or elsewhere.
- primarily paid by Medicaid. often not covered by Medicare or private insurance
Part A (Medicaid)
- covers inpatient hospital stays, skilled nursing facility stays, home health visits, and hospice care.
- benefits subject to deductible and co-insurance
Part B (Medicaid)
- covers physician visits, outpatient services, preventive services, and home health visits
- benefits are subject to a deductible and cost sharing applies
Part C (Medicaid)
refers to the Medicare Advantage program, thru which beneficiaries can enroll in private health plan, such as HMO, and receive all Medicare-covered benefits
Part D (Medicaid)
- voluntary, subsidized outpatient prescription drug benefit,w/ additional subsidies for beneficiaries of low incomes/modest assets.
- part D offered thru private plans that contract with Medicare, both stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs)
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