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Organ Procurement Organization – OPOs play a crucial role in ensuring that an immensely valuable, but scarce resource—transplantable human
organs—becomes available to seriously ill patients who are on a waiting list for an organ transplant. OPOs are responsible for identifying potential organ donors and for obtaining as many organs as possible from those donors. They are also responsible for ensuring that the organs they obtain are properly preserved and quickly delivered to a suitable recipient awaiting transplantation. Therefore, OPO performance is a critical element of the organ transplantation system in the United States. An OPO that is efficient in procuring organs and delivering them to recipients will save more lives  than an ineffective OPO.

The nation’s 58 OPOs are responsible for all organ recovery from deceased donors in the United States; without OPOs, organs from deceased donors  will not be recovered. Without recovery of organs from deceased donors, only organs from living donors will be recovered and transplanted, and many
patients waiting for organs will die.

Further reading –

https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/downloads/cms3064f.pdf

The Health Care Fraud Prevention and Enforcement Action Team – In May 2009, the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder pledged to fight waste, fraud, and abuse in Medicare with the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). With the creation of HEAT, fighting Medicare fraud has become a top priority for both Department of Justice (DOJ) and HHS. Its Mission was to assemble and strengthen significant resources across government entities to prevent waste, fraud and abuse in the Medicare and Medicaid programs and crack down on the fraud perpetrators who are abusing the system and stealing billions of dollars.

To reduce skyrocketing health care costs and improve the quality of care by ridding the system of perpetrators who are preying on Medicare and Medicaid beneficiaries and harming the short-term and long-term solvency of these essential programs.

Further reading –

https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/heat-taskforce/!ut/p/z1/tZRRU-

U.S. Department of Health & Human Services, Office of Inspector General’s (OIG) mission is to protect the integrity of Department of Health & Human Services (HHS) programs as well as the health and welfare of program beneficiaries. Since its 1976 establishment, OIG has been at the forefront of the Nation’s efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than 100 other HHS programs.

HHS OIG is the largest inspector general’s office in the Federal Government, with approximately 1,600 dedicated to combating fraud, waste and abuse and to improving the efficiency of HHS programs. A majority of OIG’s resources goes toward the oversight of Medicare and Medicaid — programs that represent a significant part of the Federal budget and that affect this country’s most vulnerable citizens. OIG’s oversight extends to programs under other HHS institutions, including the Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration.

Further reading –

https://oig.hhs.gov/

The Federal Medical Assistance Percentages (FMAPs) are used in determining the amount of Federal matching funds for State expenditures for assistance payments for certain social services, and State medical and medical insurance expenditures. The Social Security Act requires the Secretary of Health and Human Services to calculate and publish the FMAPs each year.

The “Federal Medical Assistance Percentages” are for Medicaid. Section 1905(b) of the Act specifies the formula for calculating Federal Medical Assistance Percentages.

Further reading –

https://www.medicaid.gov/medicaid/financing-and-reimbursement/

The Administration for Children & Families (ACF), a division of the U.S. Department of Health & Human Services (HHS), promotes the economic and social well-being of families, children, individuals and communities with funding, strategic partnerships, guidance, training and technical assistance. ACF promotes the economic and social well-being of families, children, individuals and communities who are resilient, safe, healthy, and economically secure. Learn more about ACF’s vision, mission and values.

Further reading –

https://www.acf.hhs.gov/

The Medicaid Information Technology Architecture (MITA) is an initiative of the Center for Medicaid & State Operations (CMSO), and it is aligned with the National Health Infrastructure Initiative (NHII) (http://aspe.hhs.gov/sp/nhii/).NHII is a voluntary network comprising clinical, public health and personal health knowledge-based information systems that make health information available as needed to improve decision-making. MITA is intended to foster integrated business and IT transformation across the Medicaid enterprise to improve the administration of the Medicaid program.

Further reading –

https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/MedicaidInfoTechArch/downloads/mitaoverview.pdf

A Qualified Intellectual Disabilities Professional (QIDP) must have at least one year of experience working directly with people with intellectual and developmental disabilities, meet the minimum federal educational requirements for a QIDP outlined in 42 CFR 483.430, and must provide documentation of both education and experience.

Direct work experience may include, but is not limited to:
• Case management or activities that include involvement with individuals in daily, work or social activities
• Interactions with consumers in the implementation of individual service plans, education plans or behavior programs
• Gathering behavior program data by interacting with or observing consumers to determine appropriate program implementation
• Involvement with consumers in programming at residential, work sites and other venues.

Persons, who would meet QIDP requirements within a reasonable time, may gain QIDP experience under the direct supervision of a trained QIDP by assisting them in collecting or collating data, drafting paperwork, organizing or recording team meetings, etc. However, only QIDPs on the Department’s QIDP database can be assigned full QIDP responsibilities (e.g., preparing ISPs, conducting meetings, assessing consumer progress, completing paperwork and signing documents that require QIDP approval). QIDPs cannot sign off on QIDP paperwork prepared by staff not approved as a QIDP, even if that staff meets QIDP requirements.

QIDPs are responsible for many things, not least of which includes ensuring that the individuals we support receive appropriate, effective, and individualized person-centered services. This training is designed to give you an overview of what your position will likely involve, as well as a
wealth of tools, tips, and resources that you can utilize in provision of those services.

Further reading –

http://www.dhs.state.il.us/OneNetLibrary/27896/documents/By_Division/Division%20of%20DD/QIDP/QIDPModule1.pdf

Home and community-based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. These programs serve a variety of targeted populations groups, such as people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses.

Further reading –

https://www.medicaid.gov/medicaid/hcbs/index.html