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Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, and people with end stage renal disease and amyotrophic lateral sclerosis.
Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.
The National Center for Health Statistics (NCHS) is a principal agency of the U.S. Federal Statistical System, which provides statistical information to guide actions and policies to improve the public health of the American people.
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.
The Joint Commission, also known as TJC, is a United States-based nonprofit tax-exempt 501(c) organization that accredits more than 22,000 US health care organizations and programs. The international branch accredits medical services from around the world. A majority of US state governments recognize Joint Commission accreditation as a condition of licensure for the receipt of Medicaid and Medicare reimbursements.
Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay. The term “outpatient” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs.
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- creating special reimbursement mechanisms that allow clinicians to practice in rural, under-served areas
- increasing utilization of physician assistants (PA) and nurse practitioners (NP)
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The 340B Drug Pricing Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to "[s]tretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services." Maintaining services and lowering medication costs for patients is consistent with the purpose of the program, which is named for the section authorizing it in the Public Health Service Act (PHSA) It was enacted by Congress as part of a larger bill signed into law by President George H. W. Bush.
References
- ↑ Joint Commission (August 1, 2014). "Facts about federal deemed status and state recognition". jointcommission.org. Retrieved 18 June 2015.
- ↑ Centers For Medicare & Medicaid Services (Cms), HHS (Apr 2008). "Medicare and Medicaid programs; conditions for coverage for end-stage renal disease facilities. Final rule". Fed Regist. 73 (73): 20369–484. PMID 18464351.
- ↑ Centers For Medicare & Medicaid Services (Cms), HHS (Oct 2011). "Medicare program; changes to the ambulatory surgical centers patient rights conditions for coverage. Final rule". Fed Regist. 76 (205): 65886–90. PMID 22022736.
- ↑ Centers For Medicare & Medicaid Services (Cms), HHS (May 2006). "Medicare and Medicaid programs; conditions for coverage for organ procurement organizations (OPOs). Final rule". Fed Regist. 71 (104): 30981–1054. PMID 16749219.
- ↑ The National Consumer Voice for Quality Long-Term Care (n.d.). "Deemed Status for Medicare and Medicaid Providers - Federal Requirements for Skilled Nursing Facilities". theconsumervoice.org. Retrieved 18 June 2015.
- 1 2 Settles, JA (October 1995). "Deemed status accreditation of nonhospital-based ambulatory surgery centers". Seminars in Perioperative Nursing. 4 (4): 199–204. PMID 7581344.
- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Centers for Medicare & Medicaid Services (6 November 2013). "Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)". cms.gov. Retrieved 18 June 2015.
- 1 2 Wish, JB (1998). "Role of external oversight in quality activities: Accreditation, credentialing, licensure, and deemed status". American Journal of Kidney Diseases. 32 (6): S177–S181. doi:10.1016/S0272-6386(98)70184-2. ISSN 0272-6386. PMID 9892388.
- ↑ Jost, Timothy Stoltzfus (1994). "Medicare and the Joint Commission on Accreditation of Healthcare Organizations: A Healthy Relationship?". Law and Contemporary Problems. 57 (4): 15–45. doi:10.2307/1192055. ISSN 0023-9186. JSTOR 1192055.
- ↑ Battard Menendez, Juliet (2010). "The Impetus for Legislation Revoking the Joint Commission's Deemed Status as a Medicare Accrediting Agency". JONA's Healthcare Law, Ethics, and Regulation. 12 (3): 69–76. doi:10.1097/NHL.0b013e3181ee276f. ISSN 1520-9229. PMID 20733410.