In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.
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.
Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.
In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.
The American Health Care Association (AHCA) is a non-profit federation of affiliated state health organizations that represents more than 14,000 non-profit and for-profit nursing homes, assisted living communities, and facilities for individuals with disabilities. The organization's president and CEO is Mark Parkinson, a former governor of Kansas. The National Center for Assisted Living (NCAL) is a part of the AHCA.
A group home, congregate living facility, care home, adult family home, etc., is a structured and supervised residence model that provides assisted living and medical care for those with complex health needs. Traditionally, the model has been used for children or young people who cannot live with their families or afford their own homes, people with chronic disabilities who may be adults or seniors, or people with dementia and related aged illnesses. Typically, there are no more than six residents, and there is at least one trained caregiver there 24 hours a day. In some early "model programs", a house manager, night manager, weekend activity coordinator, and four part-time skill teachers were reported. Originally, the term group home referred to homes of 8 to 16 individuals, which was a state-mandated size during deinstitutionalization. Residential nursing facilities, also included in this article, may be as large as 100 individuals in 2015, which is no longer the case in fields such as intellectual and developmental disabilities. Depending on the severity of the condition requiring one to need to live in a group home, some clients are able to attend day programs and most clients are able to live normal lifestyles.
Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. The ultimate goal of PACE programs is to keep eligible older adults out of nursing homes and within their communities for as long as possible. Services include primary and specialty medical care, nursing, nutrition, social services, therapies, pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health. If you or a loved one are eligible for nursing home level care but prefer to continue living at home, a PACE program can provide expansive health care and social opportunities during the day while you retain the comfort and familiarity of your home outside of day hours.
Texas state supported living centers are a collection of residential facilities run by the state for people with intellectual disabilities in Texas, United States. The schools, operated by the Texas Health and Human Services Commission operate under the Federal Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) program.
Intellectual disability (ID), also known as general learning disability and mental retardation, is a generalized neurodevelopmental disorder characterized by significant impairment in intellectual and adaptive functioning that is first apparent during childhood. Children with intellectual disabilities typically have an intelligence quotient (IQ) below 70 and deficits in at least two adaptive behaviors that affect everyday, general living. According to the DSM-5, intellectual functions include reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. Deficits in these functions must be confirmed by clinical evaluation and individualized standard IQ testing. On the other hand, adaptive behaviors include the social, developmental, and practical skills people learn to perform tasks in their everyday lives. Deficits in adaptive functioning often compromises an individual's independence and ability to meet their social responsibility.
A rural health clinic (RHC) is a clinic located in a rural, medically under-served area in the United States that has a separate reimbursement structure from the standard medical office under the Medicare and Medicaid programs. RHCs were established by the Rural Health Clinic Services Act of 1977, . The RHC program increases access to health care in rural areas by
- creating special reimbursement mechanisms that allow clinicians to practice in rural, under-served areas
- increasing utilization of physician assistants (PA) and nurse practitioners (NP)
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), formerly known as Intermediate Care Facilities for Mental Retardation (ICF/MR), is an American Medicaid-funded institutional long-term support and service (LTSS) for people with intellectual disabilities or related conditions. Section 1905(d) of the Social Security Act enacted benefits and made funding available for "institutions" for individuals with intellectual or related conditions. According to federal law 42 CFR § 440.150 the purpose of ICD/IIDs is to "furnish health or rehabilitative services to persons with Intellectual Disability or persons with related conditions."
An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".
The Center for Medicare and Medicaid Innovation is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation. CMS provides healthcare coverage to more than 100 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
Rosa's Law is a United States law which replaced several instances of "mental retardation" in law with "intellectual disability". The bill was introduced as S.2781 in the United States Senate on November 17, 2009, by Barbara Mikulski (D-MD). It passed the Senate unanimously on August 5, 2010, then the House of Representatives on September 22, and was signed into law by President Barack Obama on October 5. The law is named for Rosa Marcellino, a girl with Down syndrome who was nine years old when it became law, and who, according to President Barack Obama, "worked with her parents and her siblings to have the words 'mentally retarded' officially removed from the health and education code in her home state of Maryland."
A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided.
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.
In modern usage, retard is a pejorative term either for someone with an actual mental disability, or for someone who is considered stupid, slow to understand, or ineffective in some way. The adjective retarded is used in the same way, for something very foolish or stupid. The word is sometimes censored and referred to as the euphemistic "r‑word" or "r‑slur".
The New York State Office for People With Developmental Disabilities (OPWDD) is an executive agency in the state of New York, whose mission is to provide services and conduct research for those with intellectual disabilities and developmental disabilities (I/DD). It is one of New York State’s largest agencies, with a mandate to provide services and supports to more than 130,000 people with intellectual or developmental disabilities and leads a workforce of more than 22,000 direct support staff, clinicians, nurses, researchers and other professionals throughout the state. It operates 13 Developmental Disabilities Services Offices which operate group homes for the individuals with intellectual and developmental disabilities in its care. Prior to July 2010, the agency was named the Office of Mental Retardation and Developmental Disabilities.
As of 2017, approximately 1.4 million Americans live in a nursing home, two-thirds of whom rely on Medicaid to pay for their care. Residential nursing facilities receive Medicaid federal funding and approvals through a state health department. These facilities may be overseen by various types of state agency.
Deemed status is a hospital accreditation for hospitals in the United States.
