Category: Amazing Free Content

Statistical Enrollment Data System – States submit quarterly and annual CHIP statistical data to CMS through the SEDS automated reporting system (U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2010, p. 47). Using forms provided by CMS, states report unduplicated counts of the number of children under age 19 who are enrolled in separate CHIPs and Medicaid expansion CHIPs. SEDS is a web-based system maintained by CMS since 2000 that collects new and total Medicaid and CHIP enrollment data from states on a quarterly basis. States must submit quarterly enrollment data within 30 days after the end of the fiscal quarter and aggregate annual data within 30 days after the end of the fourth quarter.46 This analysis uses quarterly and annual total enrollment data from three of the SEDS reporting forms and, to our knowledge, is the first analysis to do so.

Further reading –

https://www.ncbi.nlm.nih.gov/books/NBK209626/

Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs.

Further reading –

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801194/

A request for proposal (RFP) is a document that solicits proposal, often made through a bidding process, by an agency or company interested in procurement of a commodity, service, or valuable asset, to potential suppliers to submit business proposals.

Further reading –

https://tenderspage.com/everything-need-know-rfp-process/

Qualifying Disabled and Working Individual – QDWI is a less common Medicare Savings Program (MSP) administered by each state’s Medicaid program. It pays the Medicare Part A premium for people who are under 65, have a disabling impairment, continue to work, and are not otherwise eligible for Medicaid.

Further reading –

https://www.benefits.gov/benefits/benefit-details/6180

A resident’s personal needs allowance is an amount required to be deducted from the computation of a resident’s patient liability to be used for the purchase of goods and services of the individual’s choosing that are not covered under Medicare or Medicaid. Personal Need Allowance (PNA) Accounts and Other Resident Funds for Nursing Facilities (NFs)” paragraph (B)(2) states
that “The PNA account is the exclusive property of the resident, who may use the funds in the account as he or she chooses to meet personal needs.”(emphasis added) Examples of items and services that the resident may request which would be chargeable to their PNA account includes, but is not limited to, items such as personal clothing, reading materials, and social events or entertainment offered outside of the facility’s activities program.

Though not required to, the resident may request the assistance of the NF to manage their PNA account. If the resident requests such assistance through written authorization, the funds still remain the property of the resident to use as they choose and are to be released, up to and including the resource limit amount, to that resident upon discharge. OAC 5101:3-3-16.5(G)(2) specifically states that “Other than for items and services that the resident has requested and that may be charged to the resident’s PNA account in accordance with this rule, a NF provider shall not withhold PNA account funds to pay any outstanding balance a resident owes the provider at the time of discharge.”(emphasis added) Likewise, upon the death of the resident, the balance of the resident’s PNA funds become a part of the deceased resident’s estate.

Further reading –

https://www.cga.ct.gov/PS99/rpt%5Colr%5Chtm/99-R-0025.htm

The Total Cost of Care (TCOC) includes all costs associated with treating members including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services.

Further reading –

https://www.qualitymeasures.ahrq.gov/summaries/summary/38363?

Per Member Per Month – This measure is used to assess the total cost of care population-based per member per month (PMPM) index.

Further reading –

https://www.qualitymeasures.ahrq.gov/summaries/summary/38363?

The Public Health Accreditation Board is a 501(c)3 nonprofit organization dedicated to improving and protecting the health of the public by advancing and ultimately transforming the quality and performance of state, local, tribal, and territorial public health departments.

Further reading –

http://www.phaboard.org/