medicaid ch 15 part 1
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dinabobina27 on October 6, 2010
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37 terms
Terms | Definitions |
|---|---|
 In 1985 Congress passed Title 19 of the Social Sequrity Act, establishing a federal mandated | state administered MEDICAL ASSITING PROGRAM for individuals woth incomes below the federal poverty level |
| Medicaid provides medical and health-related services to certain individuals and families with | low incomes and limited resources (the "medically indigent") |
| Within broad federal guidelines each state | Establishes its own eligibilty standards, Determines the type, amount, duration, and scope of services, Sets rates of payment for services, Adminsters its own program |
| Each state adminsters its own MEdicaidprogram and | CMS monitors the programs and establishes requirements for the delivry, funding, and quality of services as well as eligibilty criteria |
| TANF also known as | Temporary Assistance for Needy Families |
| Families who meet states Temporary Assistance for Needy Families (TANF) (Categorically Needy Groups) | eligibilty requirements in effective on July 16, 1996 |
| Pregnant women and children under age 6 whose family income is (Categorically Needy Groups) | at or below 133% of the federal poverty level |
| Individuals and couples living in medical institutions who have a (Categorically Needy Groups) | monthly income up to 300% of the SSI income |
| MEdicaly needy is NOT | for patients convinence |
| Medically Needy Program | expand eligibilty to additional qualified persons who may have too much income to qualify under the categorically needy group |
| TemporarY Assistance For Needy FAmilies (TANF) makes cash assistance available for a limited time for children deprived of support because of a patient's | absence, death, incapacity, or unemployment |
| Tanf was previously called the | Aid to families with Dependent Children (AFDC) program |
| States are required to extend Medicaid eligibilty to all children born after Sept. 30 1983 who reside in families with | incomes at or below the federal poverty level, untill they reach age 19 |
| State Children's Health Insurance Program also known as | SCHIP |
| BBA also known as | Balanced Budget Act |
| BBA allows states to | provide 12 mos. of continous Medicaid coverage (w/o reevaluation) for eligible children under age 19 |
| Programs of all-inclusive care aka | PACE |
| Programs of all-inclusive care (pace) use a | capitated payment system to provide a comprehensive package of community-based services as an alternative to institutional care for persons age 55 or older who require a NURSING FACILITY LEVEL OF CARE |
| PACE is part of the | Medicaid program, but is an optinal service for Medicaid plans |
| When a PACE participant needs to use a | noncontract provider, physcician, or other entity, there is a limit on the amount that these noncontract entities can charge the PACE program |
| Community Spouse income is NOT | avalible to the spouse who resides in the facility, and the two individuals are not considered a couple for income eligibilty purposes |
| Medicare Catastrophic Coverage Act of 1988 (MCCA) implemented Spousal Improvershiment Protection Legislation in 1989 to prevent | married couples from being required to spend down income and other liquid assets (cash an property) before one of the partners could be declared eligible for Medicaid coverage for nursing facility care |
| MCCA | Medicare Catostrophic ACT |
| Eligibilty in many cases will depend on | the patient's monthly income |
| EARLY AND PERIODIC SCREENING DIAGNOSTIC TREATMENT SERVICES | EPSDT |
| EARLY AND PERIODIC SCREENING DIAGNOSTIC TREATMENT SERVICES consist of | routine pediatric checkups provided to all children enrolled in MEdicaid, including dental, hearing screening and vision services |
| Retroactive eligibilty is sometimes granted to patients whose ncome has fallen below the | state-set eligibilty level and wh had high medical expenses prior to filling for Medicaid |
| Inpatient hospital (Medicaid eligibilty groups) | exluding inpatient services in institutions for mental disease |
| Outpatient hospital including Federal Qualified health Centers (FQHCs) and if (Medicaid eligibilty groups) | permitted under state law, rural health clinic (RHC) and other ambulatory services provided by a rural health clinic that are otherwise included under states plans |
| Other labatory and (Medicaid eligibilty groups) | x-ray |
| Certified pediatric and family nurse practitioners (Medicaid eligibilty groups) | when liscensed to practice under state law |
| Nursing faciliy for services for (Medicaid eligibilty groups) | beneficiares age 21 and older |
| Early and priodic screening, diagnosis, and treatment (EPSDT) for (Medicaid eligibilty groups) | children under age 21 |
| Family planning services and (Medicaid eligibilty groups) | supplies |
| Physcian's (Medicaid eligibilty groups) | services |
| Medical and surgical services (Medicaid eligibilty groups) | of a dentist |
| Home health services for benficiaries entitled to a (Medicaid eligibilty groups) | nursing facility services under the state's Medicaid plan |
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