The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital Emergency Departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.
Nursing homes, also known as old people's homes, care homes, rest homes, and convalescent homes, provide residential care for elderly or disabled people that often includes around-the-clock nursing care. Often these terms have slightly different meanings in the same or different English-speaking countries to indicate that the institutions are public or private or provide mostly assisted living or more or less nursing care and emergency medical care. A nursing home is a place for people who do not need to be in a hospital but cannot be cared for at home. The nursing home facility nurses have the responsibility of caring for the patients medical needs and also the responsibility of being in charge of other employees, depending on ranks. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
TennCare is the state Medicaid program in the U.S. state of Tennessee. TennCare was established in 1994 under a federal waiver that authorized deviations from the standard Medicaid rules. It was the first state Medicaid program to enroll all Medicaid recipients in managed care. When first implemented, it also offered health insurance to other residents who did not have other insurance. Over time, the non-Medicaid component of the program was significantly reduced.
A Federally Qualified Health Center (FQHC) is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. This designation is significant for several health programs funded under the Health Center Consolidation Act.
In the United States, charity care is health care provided for free or at reduced prices to low income patients. The percentage of doctors providing charity care dropped from 76% in 1996-97 to 68% in 2004-2005. Potential reasons for the decline include changes in physician practice patterns and increasing financial pressures. In 2006, Senate investigators found that many hospitals did not inform patients that charity care was available. Some for-profit hospitals provided as much charity care as some non-profit hospitals. Investigators also found non-profit hospitals charging poor, uninsured patients more than they did patients with health insurance.
Dual-eligible beneficiaries refers to those qualifying for both Medicare and Medicaid benefits. In the United States, approximately 9.2 million people are eligible for "dual" status. Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries.
Supplemental needs trust is a US-specific term for a type of special needs trust. Supplemental needs trusts are compliant with provisions of US state and federal law and are designed to provide benefits to, and protect the assets of, individuals with physical, psychiatric, or intellectual disabilities, and still allow such persons to be qualified for and receive governmental health care benefits, especially long-term nursing care benefits, under the Medicaid welfare program.
The California Medical Assistance Program is California's Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level. Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long term care and supports. Approximately 13.3 million people were enrolled in Medi-Cal as of January 2018, or about one-third of California's population; in Tulare County and Merced County, more than 50% of county residents were enrolled as of September 2015.
The United States government provides funding to hospitals that treat indigent patients through the Disproportionate Share Hospital (DSH) programs, under which facilities are able to receive at least partial compensation.
Florida has several Medicaid Waiver Programs. Medicaid Waiver Programs allow recipients to 'waive' institutionalization and instead choose to direct services to assist them to live in the community. Waiver program services may offer additional supports and services than provided by traditional Medicaid.
The Ohio Department of Aging is the administrative department of the Ohio state government responsible for delivery of services and support that improves and promotes quality of life and personal choice for older Ohioans, adults with disabilities, their families and their caregivers. The director of the department is the chief advisor to the Governor concerning issues affecting older Ohioans and policy changes at the federal Administration on Aging.
The Albany Health and Human Services Corporation (AHHSC) is a proposed public benefit corporation (PBC) of Albany County, New York, and New York State. On May 11, 2009, Albany County Comptroller Michael Conners in his "2009 State of Fisc" proposed a PBC for health in Albany County. On June 9, 2009, the Albany County, Legislature adopted Resolution 205, which directs the County Executive to develop a plan for the long-term care of the elderly in Albany County.
Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/MR) is a disability benefit that is offered through United States Medicaid funding. Section 1905(d) of the Social Security Act enacted benefits and made funding available for "institutions" for individuals with mental retardation or developmental disabilities (MR/DD), the Act states these facilities providing for the MR/DD population must provide adequate "active treatment," currently defined by Secretary of the U.S. Department of Health and Human Services.
The state of North Carolina is undertaking a comprehensive policy shift on how the government budgets for and manages resources for mental health, developmental disability, and substance abuse services. The 1915 (b)(c) Medicaid Waiver Program was chosen by the North Carolina Department of Health & Human Services, Division of Medical Assistance as a way to control and more accurately budget for the rising costs of Medicaid funded services. The 1915 (b)(c) Waiver Program was initially implemented at one pilot site in 2005 and evaluated for several years. Two expansion sites were then added in 2012. Full statewide implementation is expected by July 1, 2013.
The Patient Protection and Affordable Care Act (PPACA) is divided into 10 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020. Below are some of the key provisions of the ACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.
Home and Community-Based Services waiver (HCBS) programs are designed to provide long-term care services such as work supports, supervised community living, and respite care to vulnerable populations. Types of HCBS waivers may include care services for adults 65 or older, individuals living with acquired brain injuries, individuals living with intellectual disabilities, and individuals living with other physical disabilities.
In the United States, there are different kinds of residential "nursing" facilities which have in common Medicaid federal funding and approvals through a state health department, no matter which categorical state department operates, staffs or oversees the facilities. The newer community versions, small in size rather than the exposed institutions, were developed around 1970s as part of the movement to the community. Assisted living came from community living (CL) groups who advocated for the separation of facility funding to home and supports in the communities. Board and care homes have never been approved by community planning as intermediate care facilities (ICFs), or even the emblematic group homes, often falling far short at health and community gates. The leading practice in the US is to advocate for community Long Term Services and Supports (LTSS) led by groups such as the Consortium of Citizens with Disabilities representing over 200 national disability organizations.
