Advance Planning Document (APD) refers to an Initial advance automated data processing planning document or Initial APD, providing a recorded plan of action to request funding approval for a project which will require the use of ADP services or equipment, including the use of shared or purchased services in lieu of State acquired stand-alone resources.
Further reading –
https://www.acf.hhs.gov/sites/default/files/ocse/apd_guide_2.pdf
Balanced Budget Refinement Act of 1999 (PL 106113) – The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 [1] (also called the Balanced Budget Refinement Act or BBRA) is a federal law of the United States, enacted in 1999.[2] The BBRA was first introduced into the House as H.R. 3075 on October 14, 1999 by Rep. William M. Thomas (R-CA) with 75 cosponsors. It was read twice and then referred to the Senate Committee on Finance. The bill was then slightly altered and reintroduced by Thomas as H.R. 3426 on November 17, 1999. After referral to the House committees on Ways and Means and Commerce, it was incorporated by cross-reference in the conference report into H.R. 3194 on November 18, 1999. The H.R. 3194 bill had been introduced by Rep. Ernest J. Istook, Jr. (R-OK) on November 2, 1999, and was enacted with official title: Making consolidated appropriations for the fiscal year ending September 30, 2000, and for other purposes. The State Health Insurance Trial (SCHIP or S. H. 1 – T) was administered by the United States Department of Health and Human Services.
The BBRA was signed by President Bill Clinton on November 29, 1999 after passing in Congress.
Further reading –
https://www.congress.gov/bill/106th-congress/house-bill/3426/
Developmental Disabilities – A severe, chronic disability of a person 5 years of age or older which:
(a) Is attributable to a mental or physical impairment or is a combination of mental and physical impairments;
(b) Is manifested before the person attains age twenty-two;
(c) Results in substantial functional limitations in three or more of the following areas of major life activity:
and (e) reflects the person’s need for a combination and sequence of special, interdisciplinary or generic care, treatment or other services which are lifelong or extended duration and are individually planned and coordinated; except that such term, when applied to infants and young children (meaning individuals from birth to age 5, inclusive),who have substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in developmental disabilities if services are not provided.
Further reading –
Durable Medical Equipment – Medicare Part B (Medical Insurance) covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:
Durable (can withstand repeated use)
Used for a medical reason
Not usually useful to someone who isn’t sick or injured
Used in your home
Has an expected lifetime of at least 3 years
Further reading –
https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html
Fraud & Abuse – Medicare and Medicaid fraud, waste, and abuse affect every American by draining critical resources from our health care system, and contribute to the rising cost of health care for all. Taxpayer dollars lost to fraud, waste, and abuse harm multiple parties, particularly some of our most vulnerable citizens.
Fraud occurs when someone intentionally executes or attempts to execute a scheme to obtain money or property of any health care benefit program. The primary difference between fraud and abuse is intention.
Abuse occurs when health care providers or suppliers perform actions that directly or indirectly result in unnecessary costs to any health care benefit program. While some fraud schemes may involve legitimate care, some fraud schemes never involve real care, such as false storefronts pretending to operate a business.
Each working day, Medicare processes over 4.6 million claims, of which 200,000 are for durable medical equipment, from a total of 1.5 million fee-for-service providers.
Each year, Medicaid processes 3.9 billion claims, representing more than $430 billion paid annually, for more than 57 million beneficiaries.
Further reading –
https://www.cms.gov/Outreach-and-Education/Look-Up-Topics/Fraud-and-Abuse/Fraud-page.html
Federally Qualified Health Center – is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. Thus, they are a critical component of the health care safety net.[1] FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities.
Further reading –
https://en.wikipedia.org/wiki/Federally_Qualified_Health_Center
National Institute on Aging – NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. NIA is the primary Federal agency supporting and conducting Alzheimer’s disease research.
Further reading –
Medicare Benefit Notice – A notice you get after your doctor files a claim for Part A services in the Original Medicare Plan. It says what the provider billed for, the Medicare-approved amount, how much Medicare paid, and what you must pay. You might also get an Explanation of Medicare Benefits (EOMB) for Part B services or a Medicare Summary Notice (MSN). (See Explanation of Medicare Benefits; Medicare Summary Notice.)
Further reading –
Skilled Nursing Facility – Many nursing homes are also certified as a Medicare skilled nursing facility (SNF), and most accept long term care insurance and private payment. … If the nursing home is not Medicaid certified, he or she would have to transfer to a NF in order to be covered by the Medicaid Nursing Facility benefit. Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.
Further reading –
https://www.cms.gov/Center/Provider-Type/Skilled-Nursing-Facility-Center.html
The National Institute of Mental Health (NIMH) is the lead federal agency for research on mental disorders. NIMH is one of the 27 Institutes and Centers that make up the National Institutes of Health (NIH), the largest biomedical research agency in the world. NIH is part of the U.S. Department of Health and Human Services (HHS).
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