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2013-08-20 20:32:05

Important terms
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  1. What is ACA
    • Affordable Care Act
    • In March 2010, President Obama signed comprehensive health reform, the
    • Patient Protection and Affordable Care Act (ACA), into law. The law
    • makes preventive care—including family planning and related
    • services—more accessible and affordable for many Americans.
  2. HIPAA
    The Health Insurance Portability and Accountability Act of 1996

    • The HIPAA Privacy regulations require health care providers and
    • organizations, as well as their business associates, develop and follow
    • procedures that ensure the confidentiality and security of protected
    • health information (PHI) when it is transferred, received, handled, or
    • shared
  3. PHI
    • Protected Health Information
    • under HIPAA includes any individually
    • identifiable health information. Identifiable refers
    • not only to data that is explicitly linked to a particular
    • individual (that's identified information). It also includes health information with data items which reasonably
    • could be expected to allow individual identification.
  4. PII
    • Personal Identifiable Information
    • Any Information that Identifies a particular  individual, including name, address, health information, date of birth
  5. IAP
    • Insurance Affordability Program
    • Ex of Insurance affordable Program (Child health plus or medicaid
  6. UI
    Unemployment Insurance
  7. FTI
    Federal Tax Return Information
  8. FPBP
    • Family Planning Benefit Plan
    • The FPBP is a public health insurance program for New Yorkers who need
    • family planning services, but may not be able to afford them. It is intended to increase access to confidential family
    • planning services and to enable teens, women and men of childbearing age
    • to prevent and/or reduce the incidence of unintentional pregnancies.
  9. NYHBE
    New York Health Benefit Exchange
  10. CHIP
    • New York State has a health insurance plan for kids, called Child Health
    • Plus. Depending on your family's income, your child may be eligible to join either Children's Medicaid or Child Health Plus. Both Children's Medicaid and Child Health Plus are available through dozens of providers throughout the state.
  11. EHB
    • Essential Health Benefits
    • Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services;
    • emergency services; hospitalization; maternity and newborn care; mental
    • health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and
    • vision care
  12. IAP
    Insurance Affordability Program (ex. CHIP, FPBP, APTC,CSR)
  13. APTC
    • Advance Premium Tax Credits
    • The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace.
    • Advance payments of the tax credit can be used right away to lower your monthly premium costs
  14. CSR
    • Cost Sharing Reduction
    • A discount that lowers the amount you have to pay out-of-pocket for
    • deductibles, coinsurance, and copayments. You can get this reduction if
    • you get health insurance through the Marketplace, your income is below a
    • certain level, and you choose a health plan from the Silver plan
    • category
  15. QHP
    • Qualified Health Plan
    • Commercial Health Plans Approved to be sold in the Marketplace
  16. AI
    American Indian
  17. AN
    Alaskan Native
  18. I/T/U
    • Indian Health Services
    • Tribal/Tribes Oraganization
    • Urban Indian Organizations
  19. MAGI
    • Modified Adjusted Gross Income
    • The sum of adjusted gross Income found on an individuals tax return and tax exempt, itemized income
    • All Insurance Affordability Programs (IAP) use MAGI Rules- meaning medicaid and MSP (Medicare Savings Program)
  20. IAP
    In person assistor (Navigator Program)
  21. CAC
    Certified Application Counselors
  22. ACD
    Automated Call Distribution
  23. CTI
    Computer Telephone Interogation
  24. CRM
    Customer Relationship Management (AKA Siebel)
  25. IVR
    Integrated Voice Recognition/ Computer Voice
  26. CIBIC
    • Common Identification Card
    • (Medicaid/Snap/Money Card) Presented at local doctors offices along with managed care plan car if in that type of program)
  27. OK
    Oracle Knowledge
  28. SWCC
    State Wide Call Center
  29. QHP
    Qualified Health Plan
  30. EPO
    Oxford Exclusive Provider Organization
  31. ESHI
    Employer Sponsored Health Insurance
  32. FHP
    Family Health Plan
  33. FHP-PAP
    Family Health Plan Premium assistance program
  34. ICF/DD
    Care Facility For The Developmentally Disabled
  35. FHQ
    Family Health Plus
  36. FDA
    Food Drug Administration
  37. Non Magi
    • Ex. Non Magi( SSI, Foster Care)
    • Individuals who are 65 an older
    • Blind or disabled
    • requesting to cover LTC (Long Term Care)
    • Medically needy
    • Medicaid Buy in for working persons with disabilities

    Medicare Savings Program (MSP- Which are- QMB, SLMB, QI)
  38. MSP
    • Medicare Savings Program
    • (QMB-Qualified Medicare Beneficiaries)
    • (SLMB-Specified Low Income Medicare Benefits)
    • (QI- Qualified Disable)
  39. Define CHIP
    New York State has a health insurance plan Children-Depending family's income. Child Can join children's medicaid or child health plus

    • Eligibility
    • Child under 19
    • New York Resident
    • Child Can't have other health Insurance (Exempt to this rule- Accident insurance, automobile insurance, workers compensation)

    • How to apply for CHIP?
    • Until 11/16/13 NYS DEPT of Health website
    • Participating Health plans
    • Market Place

    • Time Frame
    • Until 11/16/13-If applied through health plan- no retroactive enrollment

    If app receive by 20th- coverage first day of the month

    If app receive after 20th enrollment begins the subsequent month
  40. How long are children enrolled in CHIP
    12 months
  41. What does CHIP cost family
    • Varies, based on household income and family size
    • Coverage may be free or available at a low cost
  42. How are families billed CHIP premiums
    • Receive Monthly Bill
    • Payment due 30 days in advanced of the month
  43. How Long wait after applying CHIP
    • If app before 11/16/13- 6 months
    • If through Market place- beginning 12/13 90 day waiting period (must be uninsured before enrolling in CHIP)
  44. When is CHIP Card send?
    If apply through health plan- within 14 days
  45. PE
    • Presumptive Eligibility
    • A way to receive medical coverage two months while documents have not been submitted yet
    • Available once per plan per lifetime
    • Documents must be submitted no later than two months PE was granted
  46. What is MA
    Stands for Medicaid
  47. Define Medicare
    • 1) National, federally funded insurance program
    • 2) Administered by government since 1965
    • 3) Guarantees insurance for Americans 65 and older and people who are disabled as well as people with Renal Diseases (permanently Kidney failures- requiring dialysis or kidney transplant)
  48. What does Medicare Offer?
    • Part A-automatic inpatient services
    • Part B- outpatient services
    • Part C- selecting private companies (advantage medicare). If get this- receive A and B
    • Part D- Prescription Drugs

    Medicare Covers half of health care cost, enrolles cover the rest
  49. Out of Pocket Expenses
    Varies depending on the amount of health care a medicare enrollee needs

    • Ex. of out of pocket expenses
    • LTC (long Term Care)
    • Dental, hearing, and vision
  50. How is Medicare funded?
    • Part A funded by employers and workers taxes
    • Part B&D are funded by premiums paid by medicare enrollees
  51. Medicare Eligibility
    • 65 years old and older
    • disabled can be below 65 and receive SSI
    • Legal Resident, 5 years at least
  52. How are premiums waived for Medicare Part A
    • 65 years old older
    • US Citizens pay taxes 10 years
    • or under 65, disabled and receive SSDI
    • They must receive this benefit for at least 24 months
    • or on continue dialysis or renal deseases
  53. What is it called when receiving Medicare and Medicaid?
    Dual Eligibility
  54. TPHI
    Third Party Health Insurance
  55. HCBC
    Home Community Based Services

    To provide services and supports for adults and children of all ages and their families to enable them to remain at home or in community residential settings
  56. HRA
    • Human Resource Administration
    • (local district)
  57. IAP
    Insurance Affordability Program

    • the continuum of subsidized coverage including Medicaid, CHIP, Basic Health Program and Advance
    • Premium Tax Credits (APTCs)/Cost Sharing
    • Reductions (CSRs).
  58. DFS
    Department Finance Service
  59. CMS
    Center For Medicaid/Medicare Services
  60. QHP
    Qualified Health Plans
  61. EHB
    Essential Health Benefits
  62. MSP
    Medicare Service Program
  63. PE
    Presume Eligibility
  64. FPBP
    Family Planning Benefit Program
  65. CBIC
    Common Benefit Identification Card
  66. SHOP
    Small Business Health Options program
  67. QDWI
    Qualified Disabled Working Individuals
  68. CCIIO
    Center Consumer Information Insurance Oversight
  69. DHHS
    Department of Health and Human Services
  70. ACA
    Affordable Care Act
  71. OMIG
    • Office of Medicaid Inspector General
    • (Office for suspected fraud)
  72. CSR
    Cost Sharing Reduction
  73. APTC
    Advance premium tax credit
  74. FFS
    Fee for Service
  75. FHP
    Family Health Plus
  76. ECP
    Essential Community Provider