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Common Industry Terms Used in Long Term CareResource: The following terms and definitions were modified from the U.S. Department of Health and Human Services webpage available here: https://aspe.hhs.gov/glossary-terms. TERM DEFINITIONAccess An individual's ability to obtain appropriate health care

services. Barriers to access can be financial, geographic, organizational and sociological. Efforts to improve access often focus on providing/improving health coverage.

Accessibility As required by the Americans with Disabilities Act, removal of barriers that would hinder a person with a disability from entering, functioning, and working within a facility. Required restructuring of the facility cannot cause undue hardship for the employer.

Activities of Daily Living (ADLs)

Basic personal activities which include bathing, eating, dressing, mobility, transferring from bed to chair, and using the toilet. ADLs are used to measure how dependent a person may be on requiring assistance in performing any or all of these activities.

Acute Care Care that is generally provided for a short period of time to treat a certain illness or condition. This type of care can include short-term hospital stays, doctor's visits, surgery, and X-rays. Medical treatment rendered to individuals whose illnesses or health problems are of a short-term or episodic nature. Acute care facilities are those hospitals that mainly serve persons with short-term health problems.

Acute Disease A disease that is characterized by a single episode of a relatively short duration from which the patient returns to his/her normal or previous level of activity. While acute diseases are frequently distinguished from chronic diseases, there is no standard definition or distinction.

Acute Illness Illness that is usually short-term and that often comes on quickly.

Admission Date at which an individual was reported to have been admitted to a nursing home for which a Medicaid claim has been paid. Admission may occur before the beginning of a Medicaid-financed nursing home spell if a person entered the nursing home with other insurance coverage before Medicaid began covering the nursing facility care.

Adult Care Home (Also called board and care home or group home.) Residence which offers housing and personal care services for 3 to 16 residents. Services (such as meals, supervision, and transportation) are usually provided by

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https://aspe.hhs.gov/glossary-terms

the owner or manager. May be single family home. (Licensed as adult family home or adult group home.)

Adult Day Care A daytime community-based program for functionally impaired adults that provides a variety of health, social, and related support services in a protective setting.

Advance Care Planning

The process of discussing, determining and/or executing treatment directives and appointing a proxy decision maker.

Advance Health Care Directive

(Also called advance directive.) A written instructional health care directive and/or appointment of an agency, or a written refusal to appoint an agent or execute a directive.

Adverse Drug Reaction (ADR)

An undesirable response associated with use of a drug that compromises therapeutic efficacy, enhances toxicity, or both.

Adverse Event In a medical context, an injury resulting from a medical intervention.

Age Discrimination in Employment Act (ADEA)

A 1967 federal law that prohibits employers with 20 or more employees from discriminating on the basis of age in hiring, job retention, compensation, and benefits. ADEA also sets requirements for the duration of employer-provided disability benefits.

Agency An individual designated in a legal document known as a power of attorney for health care to make a health care decision for the individual granting the power; also referred to in statute as durable power of attorney for health care, attorney in fact, or health care representative.

Allied Health Personnel

Specially trained and licensed health workers other than physicians, dentists, optometrists, chiropractors, podiatrists, and nurses. The term has no constant or agreed-upon detailed meaning; it is sometimes used synonymously with paramedical personnel, sometimes meaning all health workers who perform tasks that must otherwise be performed by a physician, and at other times referring to health workers who do not usually engage in independent practice.

Allowable Costs Items or elements of an institution's costs that are reimbursable under a payment formula. Both Medicare and Medicaid reimburse hospitals on the basis of only certain costs. Allowable costs may exclude, for example, luxury accommodations, costs that are not reasonable expenditures, or that are unnecessary for the efficient delivery of health services to persons covered under the program in question.

Alzheimer's Disease A progressive, irreversible disease characterized by degeneration of the brain cells and severe loss of memory, causing the individual to become dysfunctional and dependent upon others for basic living needs.

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Ambulatory Care All types of health services which are provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services which do not require an overnight stay. Also see ambulatory setting and outpatient.

Ambulatory Payment Classification (APC)

The basis for payment for care in the Outpatient Prospective Payment System. The APC is used in a fashion similar to the way DRGs are used for payment for inpatients. Both APCs and DRGs are intended to represent groups of patients that are similar clinically and that also have roughly the same resource consumption. The significant difference between them is that APCs depend on the procedures performed whereas DRGs depend on the diagnosis treated.

Ambulatory Setting A type of institutional organized health setting in which health services are provided on an outpatient basis. Ambulatory care settings may be either mobile or fixed.

Americans with Disabilities Act (ADA):

An individual must meet one of the following three tests: (a) have a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (b) have a record of such an impairment; or (c) be regarded as having an impairment. (Same as Section 504 of the Rehabilitation Act of 1973 and the Fair Housing Amendments of 1988.)

Ancillary Services Supplemental services, including laboratory, radiology, physical therapy, and inhalation therapy that are provided in conjunction with medical or hospital care.

Appropriateness Appropriate health care is care for which the expected health benefit exceeds the expected negative consequences by a wide enough margin to justify treatment.

Area Agency on Aging (AAA)

A local (city or county) agency, funded under the federal Older Americans Act, that plans and coordinates various social and health service programs for persons 60 years of age or more. The network of AAA offices consists of more than 600 approved agencies.

Area Health Education Center (AHEC)

An organization or organized system of health and educational institutions whose purpose is to improve the supply, distribution, quality, use, and efficiency of health care personnel in specific medically underserved areas. An AHEC's objectives are to educate and train the health personnel specifically needed by the underserved areas and to decentralize health workforce education, thereby increasing supply and linking the health and educational institutions in scarcity areas.

Artificial Nutrition (Also known as tube feeding.) Artificial nutrition and

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and Hydration hydration supplements or replaces ordinary eating and drinking by giving nutrients and fluids through a tube placed directly into the stomach (gastrostomy tube or G-tube), the upper intestine, or a vein.

Assignment A process in which a Medicare beneficiary agrees to have Medicare's share of the cost of a service paid directly ("assigned") to a doctor or other provider, and the provider agrees to accept the Medicare approved charge as payment in full. Medicare pays 80% of the cost and the beneficiary 20%, for most services. See participating physician.

Assisted Living Residences that provide a "home with services" and that emphasize residents' privacy and choice. Residents typically have private locking rooms (only shared by choice) and bathrooms. Personal care services are available on a 24-hour-a-day basis. (Licensed as residential care facilities or as rest homes.)A broad range of residential care services that includes some assistance with activities of daily living and instrumental activities of daily living, but does not include nursing services such as administration of medication. Assisted living facilities and in-home assisted living care stress independence and generally provide less intensive care than that delivered in nursing homes and other long-term care institutions.

Assisted Living Facility (ALF) Benefit Amount

The maximum amount which the policy or certificate will pay for care received in an ALF. If the benefit is paid as weekly or monthly, the daily amount should be derived by whatever convention is most appropriate for the carrier to use. The data should be the current amount on the policy in order to account both for any voluntary increases in coverage the insured has elected or any automatic coverage increases as a result of inflation protection.

Assisted Living/Other Facility Benefits Paid During Reporting Period

The total dollar amount of benefits paid during the reporting period for care provided in an ALF or similar alternate care facility other than a nursing home.

Assistive Devices Tools that enable individuals with disabilities to perform essential job functions, e.g., telephone headsets, adapted computer keyboards, enhanced computer monitors.

Automatic Inflation Protection Type

The type of inflation protection used in the policy. This includes automatic inflation protection on a compound, level-funded basis; or a simple increase and level-funded basis; a graded inflation protection feature where both the premium and the benefit amounts increase at a known and pre-set amount each year; step-rated inflation protection; level-funded increases

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based on the Consumer Price Index; level-funded increases based on the specific long-term care price index; level-funded inflation protection based on some other published index value; level-funded inflation protection based on an increase amount determined by the carrier which could change from year to year based on the changes in actual costs of care. All these types of inflation protection are provided annually and continue on claim (unless other predefined limits are reached first).

Average Wholesale Price (AWP) of Prescription Drugs

The average wholesale price of a drug relates to the price that wholesalers charge pharmacies, and is often used by pharmacists to price prescriptions. Drug manufacturers and labelers commonly publish suggested wholesale prices for their products. Price surveys of wholesalers are also available.

Avoidable Hospital Conditions

Medical diagnosis for which hospitalization could have been avoided if ambulatory care had been provided in a timely and efficient manner.

Basis of Eligibility (BOE)

Eligibility group that traditionally has been used by CMS to classify enrollees as children, adults, aged, or disabled.

Behavioral Health An umbrella term that includes mental health and substance abuse, and frequently is used to distinguish from "physical" health. Health care services provided for depression or alcoholism would be considered behavioral health care, while setting a broken leg would be physical health. See parity.

Behavioral Risk Factor Surveillance System (BRFSS)

The BRFSS, the world's largest telephone survey, tracks risk behaviors related to chronic diseases, injuries, and death in the United States. Administered and supported by the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, the BRFSS is an ongoing data collection program. By 1994, all states, the District of Columbia, and three territories were participating in the BRFSS.

Benchmark A level of care set as a goal to be attained. Internal benchmarks are derived from similar processes or services within an organization. Competitive benchmarks are comparisons with the best external competitors in the field. Generic benchmarks are drawn from the best performance of similar processes in other industries.

Beneficiary An individual who receives benefits from or is covered by an insurance policy or other health care financing program.

Bias The difference between the sample statistic and the population statistic caused by factors other than random error. If a sample statistic is biased, then

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repeating the survey many times would produce a distribution of sample statistics that would be centered around something other than the population value for the statistic. Thus, a biased sample statistic would have a tendency to be either too small or too large as an estimate of the population statistic. One common source of bias in all surveys occurs when the non-respondents have different characteristics from the respondents.

Biased Selection The market imperfection that results from the uneven grouping of risks among competing subscribers. Biased selection includes favorable selection (attracting good risks and repelling bad ones) as well as adverse selection (the reverse). Biased selection can occur naturally, according to historical or accidental patterns, or it can occur strategically, according to conscious choices by either subscribers or insurers.

Black Lung (Pneumoconiosis)

Pneumoconiosis is a disease of the lungs caused by the habitual inhalation of irritant mineral or metallic particles. A miner must meet three general conditions: (1) must have (or, if deceased, have had) pneumoconiosis; (2) be totally disabled by the disease (or have been totally disabled at the time of death); and (3) the pneumoconiosis must have arisen out of coal mine employment. Dependent coverage is also provided to widows of miners who died of Black Lung disease and to their dependents.

Blended Funding The process of integrating funds from different sources (e.g., Medicaid and block grant monies) to enhance flexibility in supporting an individualized set of services for designated patients.

Board and Care Home

(Also called adult care home or group home.) Residence which offers housing and personal care services for 3 to 16 residents. Services (such as meals, supervision, and transportation) are usually provided by the owner or manager. May be single family home. (Licensed as adult family home or adult group home.)

Board Certified Status granted a medical specialist who completes a required course of training and experience (residency) and passes an examination in his/her specialty. Individuals who have met all requirements except examination are referred to as "board eligible".

Cafeteria Benefits Plan

An arrangement under which employees may choose their own benefit structure, allowing employees to tailor their benefits package to best meet their specific needs. For example, an employee with no dependents may forgo life insurance but may prefer more comprehensive health insurance package.

Capacity An individual's ability to understand the significant benefits, risks, and alternatives to proposed health care

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and to make and communicate a health care decision. The term is frequently used interchangeably with competency but is not the same. Competency is a legal status imposed by the court.

Capital Expenditure Review

A review of proposed capital expenditures of hospitals and/or other health facilities to determine the need for, and appropriateness of, the proposed expenditures. The review is done by a designated regulatory agency and has a sanction attached that prevents or discourages unneeded expenditures.

Cardiopulmonary Resuscitation (CPR)

A group of treatments used when someone's heart and/or breathing stops. CPR is used in an attempt to restart the heart and breathing. It usually consists of mouth-to-mouth breathing and pressing on the chest to cause blood to circulate. Electric shock and drugs also are used to restart or control the rhythm of the heart.

Care Plan (Also called service plan or treatment plan.) Written document which outlines the types and frequency of the long-term care services that a consumer receives. It may include treatment goals for him or her for a specified time period.

Caregiver Person who provides support and assistance with various activities to a family member, friend, or neighbor. May provide emotional or financial support, as well as hands-on help with different tasks. Caregiving may also be done from long distance.

Care/Case Management

Offers a single point of entry to the aging services network. Care/case management assess clients' needs, create service plans, and coordinate and monitor services; they may operate privately or may be employed by social service agencies or public programs. Typically case managers are nurses or social workers. The monitoring and coordination of treatment rendered to patients with specific diagnosis or requiring high-cost or extensive services. Procedures and processes used by trained service providers or a designated entity to assist children and families in accessing and coordinating services.

Carrier A private organization, usually an insurance company that finances health care.

Case Mix A method by which a health care provider measures the service needs of the patient population, and may be based on age, medical diagnosis, severity of illness, or length of stay. A nursing home or hospital's actual case mix influences cost and scope of the services provided by the facility to the patient, and case mix reimbursement systems adjust payment rates accordingly. A measure of the mix of cases being treated by a particular health care provider that is intended to reflect the patients' different needs for

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resources. Case mix is generally established by estimating the relative frequency of various types of patients seen by the provider in question during a given time period and may be measured by factors such as diagnosis, severity of illness, utilization of services, and provider characteristics.

Case-Rate A fixed amount of money paid per person to allow a provider or designated entity to pay for covered services needed by that person; rates are typically based on diagnoses of persons who present for services and expressed as monthly amounts.

Case Severity A measure of intensity or gravity of a given condition or diagnosis for a patient.

Catastrophic Health Insurance

Health insurance that provides protection against the high cost of treating severe or lengthy illnesses or disability. Generally such policies cover all, or a specified percentage of, medical expenses above an amount that is the responsibility of another insurance policy up to a maximum limit of liability.

Certification The process by which a governmental or non-governmental agency or association evaluates and recognizes an individual, institution, or educational program as meeting predetermined standards. One so recognized is said to be "certified." It is essentially synonymous with accreditation, except that certification is usually applied to individuals, and accreditation to institutions. Certification programs are generally non-governmental and do not exclude the uncertified from practice as do licensure programs.

Certified Nurse Aide (CNA)

A nurse aide that has completed required state training and competency testing in the skills required to work as a nurse aide.

Charity Care Generally refers to physician and hospital services provided to persons who are unable to pay for the cost of services, especially those who are low-income, uninsured, and underinsured. A high proportion of the costs of charity care is derived from services for children and pregnant women (e.g., neonatal intensive care).

Chore Services Help with chores such as home repairs, yard work, and heavy housecleaning.

Chronic Care Care and treatment given to individuals whose health problems are of a long-term and continuing nature. Rehabilitation facilities, nursing homes, and mental hospitals may be considered chronic care facilities.

Chronic Disease A disease that has one or more of the following characteristics: is permanent; leaves residual disability; is caused by nonreversible pathological alternation; requires special training of the patient for rehabilitation; or may be expected to require a long

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period of supervision, observation, or care.Chronic Illness Long-term or permanent illness (e.g., diabetes,

arthritis) which often results in some type of disability and which may require a person to seek help with various activities.

Chronically Ill A patient has been certified by a licensed health care practitioner as: being unable to perform, without substantial assistance from another person, at least two ADLs for a period that is expected to last at least 90 consecutive days due to a loss of functional capacity; or requiring substantial supervision to protect themselves from threats to health and safety due to a severe cognitive impairment.

Claim Status Indicates whether or not an insured with a Partnership policy is in claim status during the reporting period.

Claims Made Policy Provides coverage for insured events that both occur and for which a claim is made during the term of the policy. If an incident occurs, but the policy is terminated before a claim is made, liability for the incident is not insured.

Claims Occurrence Policy

Provides coverage for all incidents and events that occur during the term of the policy, regardless of when a liability claim is made, or when a lawsuit is settled.

Clinic A facility, or part of one, devoted to diagnosis and treatment of outpatients. "Clinic" is irregularly defined. It may either include or exclude physicians' offices; may be limited to describing facilities that serve poor or public patients; and may be limited to facilities in which graduate or undergraduate medical education is done.

Clinical Condition A diagnosis (e.g., cerebrovascular hemorrhage) or a patient state that may be associated with more than one diagnosis (such as paraplegia) or that may be as yet undiagnosed (such as low back pain).

Clinical Event Services provided to patients (items of history taking, physical examination, preventative care, tests, procedures, drugs, advice) or information on clinical condition or on patient state used as a patient outcome.

Clinical Performance Measures

Instruments that estimate that extent to which a health care provider: delivers clinical services that are appropriate for each patient's condition; provides them safely, competently, and in an appropriate time frame; and achieves desired outcomes in terms of those aspects of patient health and patient satisfaction that can be affected by clinical services.

Clinical Practice Guidelines

Systematically developed statements to assist practitioners and patients' decisions about health care to be provided for specific clinical circumstances.

Co-Morbidity Condition that exists at the same time as the primary

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condition in the same patient (e.g., hypertension is a co-morbidity of many conditions such as diabetes, ischemic heart disease, end-stage renal disease, etc.).

Co-Payment (Also called co-insurance.) The specified portion (dollar amount or percentage) that Medicare, health insurance, or a service program may require a person to pay toward his or her medical bills or services.

Cognitive Impairment Deterioration or loss of intellectual capacity which requires continual supervision to protect the insured or others, as measured by clinical evidence and standardized tests that reliably measure impairment in the area of (1) short or long-term memory, (2) orientation as to person, place and time, or (3) deductive or abstract reasoning. Such loss in intellectual capacity can result from Alzheimer's disease or similar forms of senility or Irreversible Dementia.

Collateral Damages Damages incurred by the plaintiff that are already covered by other sources of payment. "Collateral source offset" rules reduce awards by denying plaintiffs compensation for losses that are recouped from other sources such as health insurance. These rules aim to prevent plaintiffs from "double dipping" by recovering for losses for which the plaintiff has already been remunerated through other sources of payment.

Community Health Center

(Also called neighborhood health center.) An ambulatory health care program usually serving a catchment area which has scarce or nonexistent health services or a population with special health needs. These centers attempt to coordinate federal, state, and local resources in a single organization capable of delivering both health and related social services to a defined population. While such a center may not directly provide all types of health care, it usually takes responsibility to arrange all medical services needed by its patient population.

Community Health Center (CHC)

An ambulatory health care program (defined under Section 330 of the Public Health Service Act) usually serving a catchment area that has scarce or nonexistent health services or a population with special health needs. Sometimes known as "neighborhood health center." CHCs attempt to coordinate federal, state, and local resources in a single organization capable of delivering both health and related social services to a defined population. While such a center may not directly provide all types of health care, it usually takes responsibility to arrange all health care services needed by its patient population.

Community Long-Term Care (CLTC)

Services covered under 1915(c) waivers and personal care, residential care, home health, adult day, and

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private duty nursing services provided at state option. Because unduplicated measures of community long-term care waiver use and service-specific use are not available in MAX PS files, CLTC is operationally defined as services covered under waivers for people receiving waiver services, and use of personal care, residential care, home health, adult day, and private duty nursing for all other enrollees.

Community Mental Health Center (CMHC)

An entity that provides comprehensive mental health services (principally ambulatory), primarily to individuals residing or employed in a defined catchment area.

Community Rating A method of calculating health plan premiums using the average cost of actual or anticipated health services for all subscribers within a specific geographic area. The premium does not vary for different groups or subgroups of subscribers to reflect their specific claims experience or health status. Under modified community rating (the most common form), rates may vary based on subscribers' specific demographic characteristics (such as age and gender), but rate variation based on individuals' health status, claims experience, or policy duration is prohibited. "Pure" community rating prohibits rate variation based on demographic as well as health factors, and all subscribers in an area pay the same rate.

Community Rating by Class (CRC or Class Rating)

For federally qualified HMOs, the CRC is the adjustment of community-rated premiums on the basis of such factors as age, sex, family size, marital status, and industry classification. These health plan premiums reflect the experience of all enrollees of a given class within a specific geographic area, rather than the experience of any one employer group.

Community-Based Care/Services

Services designed to help older people remain independent and in their own homes; can include senior centers, transportation, delivered meals or congregate meals site, visiting nurses or home health aides, adult day care, and homemaker services.

Company Code The 5-digit code assigned by the National Association of Insurance Commissioners to each insurance company. For self-funded plans or the Federal Employees' Long-Term Care Insurance Program (FLTCIP), a unique 5-digit code will be assigned for use in these reporting requirements.

Computerized Physician Order Entry (CPOE)

Electronic systems in which physicians enter and transmit medication orders as well as orders for radiology, lab work, and other ancillary services. Physician order entry systems help catch and prevent errors by checking physician orders against potential drug to drug interactions, normal dosages, and

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diagnostic or therapeutic guidelines. Physician order entry systems also prevent medical errors due to misreading of hand-written orders.

Conditions of Participation (COP)

Standards a facility or supplier of services, desiring to participate in the Medicare or Medicaid program, is required to meet. These conditions include meeting a statutory definition of the particular institution or facility, conforming to state and local laws and having an acceptable utilization review plan. Surveys to determine whether facilities meet conditions of participation are made by the appropriate state health agency.

Confidence Interval A range of values used to predict the location of the true population parameter. The probability of the true parameter values falling within the intervals is specified.

Congregate Housing Individual apartments in which residents may receive some services, such as a daily meal with other tenants. (Other services may be included as well.) Buildings usually have some common areas such as a dining room and lounge as well as additional safety measures such as emergency call buttons. May be rent-subsidized (known as Section 8 housing).

Consumer A person who purchases or receives goods or services for personal needs or use and not for resale.

Continuing Care Retirement Community (CCRC)

Communities which offer multiple levels of care (independent living, assisted living, and skilled nursing care) housed in different areas of the same community or campus and which give residents the opportunity to remain in the same community if their needs change. Provide residential services (meals, housekeeping, and laundry), social and recreational services, health care services, personal care, and nursing care. Require payment of a monthly fee and possibly a large lump-sum entrance fee. (Licensed as nursing homes/residential care facilities or as homes for the aging.)

Continuing Medical Education (CME)

Formal education obtained by a health professional after completing his/her degree and full-time post-graduate training. For physicians, some states require CME (usually 50 hours per year) for continued licensure, as do some specialty boards for certification.

Continuum of Care The entire spectrum of specialized health, rehabilitative, and residential services available to the frail and chronically ill. The services focus on the social, residential, rehabilitative and supportive needs of individuals as well as needs that are essentially medical in nature. Clinical services provided during a single inpatient hospitalization or for multiple conditions over a lifetime. It provides a basis for evaluating quality,

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cost, and utilization over the long term.Cost Center An accounting device whereby all related costs

attributable to some "financial center" within an institution, such as a department or program, are segregated for accounting or reimbursement purposes.

Cost of Living Adjustment/Allowance (COLA)

Increase to a monthly long-term disability benefit, usually after the first year of payments. May be a flat percentage (e.g., 3%) or tied to changes in inflation. In some states, workers' compensation income replacement benefits also include annual COLAs.Increase to an individual's salary or other benefit payment, usually after the first year of payments. May be a flat percentage (e.g., 3%) or tied to changes in inflation. For example, in some states, workers' compensation income replacement benefits or long-term disability benefits include annual COLAs.

Cost-Based Reimbursement

Payment made by a health plan or payer to health care providers based on the actual costs incurred in the delivery of care and services to plan beneficiaries. This method of paying providers is still used by some plans; however, cost-based reimbursement is being replaced by prospective payment and other payment mechanisms.

Cost-Benefit Analysis An analytic method in which a program's cost is compared to the program's benefits for a period of time, expressed in dollars, as an aid in determining in best investment of resources. For example, the cost of establishing an immunization service might be compared with the total cost of medical care and lost productivity that will be eliminated as a result of more persons being immunized. Cost-benefit analysis can also be applied to specific medical tests and treatments.

Cost-Effectiveness Analysis (CEA)

A form of analysis that seeks to determine the costs and effectiveness of a medical intervention compared to similar alternative interventions to determine the relative degree to which they will obtain the desired health outcome(s). Cost-effectiveness analysis can be applied to any of a number of standards such as median life expectancy or quality of life following an intervention.

Coverage The guarantee against specific losses provided under the terms of an insurance policy. Coverage is sometimes used interchangeably with benefits or protection, and is also used to mean insurance or insurance contract.

Coverage Decision A policy decision about categories of health interventions or benefits that will be provided to a population of patients as part of the contract between a health plan and a beneficiary.

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Covered Entity Refers to three types of entities that must comply with federal health information privacy regulations (e.g., HIPAA Privacy Rule): health care providers, health plans, and health care clearinghouses. For these purposes, health care providers include hospitals, physicians, and other caregivers, as well as researchers, who provide health and care receive, access, or generate individually identifiable health care information.

Covered Services Health care services covered by an insurance plan.Credentialing The recognition of professional or technical

competence. The re-credentialing process may include registration, certification, licensure, professional association membership, or the award of a degree in the field. Certification and licensure affect the supply of health personnel by controlling entry into practice and influence the stability of the labor force by affecting geographic distribution, mobility, and retention of workers. Credentialing also determines the quality of personnel by providing standards for evaluating competence and by defining the scope of functions and how personnel may be used.

Critical Access Hospital (CAH)

A rural hospital designation established by the Medicare Rural Hospital Flexibility Program (MRHFP) enacted as part of the 1997 Balanced Budget Act. Rural hospitals meeting criteria established by their state may apply for critical access hospital status. Designated hospitals are reimbursed based on cost (rather than prospective payment), must comply with federal and state regulations for CAHs, and are exempt from certain hospital staffing requirements.

Current Annual Premium

The amount of annual premium being paid for the coverage, including both the insured's portion and any portion paid by the employer, if applicable. This would reflect the current premium amount such that any voluntary changes in coverage that might have increased or decreased the premium from its original issue amount would be reflected in this figure.

Current Claimant Refers to an insured who is in active claim status which means that they meet the definition of chronically ill and are receiving benefit payments in accordance with the coverage provisions and requirements of the policy or certificate.

Custodial Care Care that does not require specialized training or services. (See also personal care.)

Customary Charge One of the factors determining a physician's payment for a service under Medicare. Calculated as the physician's median charge for that service over a prior 12-month period.

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Customary, Prevailing, and Reasonable (CPR)

Current method of paying physicians under Medicare. Payment for a service is limited to the lowest of: (1) the physician's billed charge for the service; (2) the physician's customary charge for the service; or (3) the prevailing charge for that service in the community. Similar to the Usual, Customary, and Reasonable system used by private insurers.

De-Identification A process whereby information that could identify the clinician, the reporter, the health care institution, or another organization involved in a medical error are removed from an error report after it is received. This process is used to maintain records of factors that could cause errors, but assure those who report errors that their reports will not be used in civil lawsuits against them.

Deductible Initial amount of claims incurred by the policyholder not covered by the insurance policy. Insurance coverage begins only for losses incurred above the deductible amount.The amount of loss or expense that must be incurred by an insured or otherwise covered individual before an insurer will assume any liability for all or part of the remaining cost of covered services. Deductibles may be either fixed-dollar amounts or the value of specified services (such as two days of hospital care or one physician visit). Deductibles are usually tied to some reference period over which they must be incurred (e.g., $100 per calendar year, benefit period, or spell of illness).

Deinstitutionalization Policy which calls for the provision of supportive care and treatment for medically and socially dependent individuals in the community rather than in an institutional setting.

Dementia Term which describes a group of diseases (including Alzheimer's Disease) which are characterized by memory loss and other declines in mental functioning.

Developmental Disability (DD)

A disability which originates before age 18, can be expected to continue indefinitely, and constitutes a substantial handicap to the disabled's ability to function normally.A severe, chronic disability that is attributable to a mental or physical impairment or combination of mental and physical impairments; is manifested before the person attains age 22; is likely to continue indefinitely; results in substantial functional limitations in three or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity of independent living, economic self-sufficiency; and reflects the person's needs for a combination and

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sequence of special, interdisciplinary, or generic care treatments of services which are of lifelong or extended duration and are individually planned and coordinated.

Direct Cost A cost which is identifiable directly with a particular activity, service, or product of the program experiencing the costs. These costs do not include the allocation of costs to a cost center which are not specifically attributable to that cost center.

Direct Patient Care Any activities by a health professional involving direct interaction, treatment, administration of medications, or other therapy or involvement with a patient.

Disability The limitation of normal physical, mental, social activity of an individual. There are varying types (functional, occupational, learning), degrees (partial, total), and durations (temporary, permanent) of disability. Benefits are often available only for specific disabilities, such as total and permanent (the requirement for Social Security and Medicare).

Disaster Drill An exercise, or demonstration, that tests the readiness and capacity of a hospital, a community, or other system to respond to a public health emergency or other disaster.

Discharge The release of a patient from a provider's care, usually referring to the date at which a patient checks out of a hospital.

Disease May be defined as a failure of the adaptive mechanisms of an organism to counteract adequately, normally, or appropriately to stimuli and stresses to which it is subjected, resulting in a disturbance in the function or structure of some part of the organism. This definition emphasizes that disease is multi-factorial and may be prevented or treated by changing any or a combination of the factors. Disease is a very elusive and difficult concept to define, being largely socially defined. Thus, criminality and drug dependence are presently seen by some as diseases, when they were previously considered to be moral or legal problems.

Disease Management The process of identifying and delivering care within the selected patient populations (e.g., patients with asthma or diabetes) the most efficient, effective combination of resources, interventions, or pharmaceuticals for the treatment or prevention of a disease. Disease management could include team-based care where physicians and/or other health professionals participate in the delivery and management of care. It also includes the appropriate use of pharmaceuticals.

Do Not Resuscitate Order

(Also called a DNR order, a No CPR order, a DNAR order (do not attempt resuscitation), and an AND order (allow natural death).) A physician's order

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written in a patient's medical record indicating that health care providers should not attempt CPR in the event of cardiac or respiratory arrest. In some regions, this order may be transferable between medical venues.

Dual Eligible A person who is eligible for two health insurance plans, often referring to a Medicare beneficiary who also qualifies for Medicaid benefits.

Durable Medical Equipment (DME)

(Also called home medical equipment.) Equipment such as hospital beds, wheelchairs, ventilator, oxygen system, home dialysis system, and prosthetics used at home. May be covered by Medicaid and in part by Medicare or private insurance. Prescribed by a physician for a patient's use for an extended period of time.

Electronic Claim A digital representation of a medical bill generated by a provider or by the provider's billing agent for submission using telecommunications to a health insurance payer.

Emergency Medical Services (EMS)

Services utilized in responding to the perceived individual need for immediate treatment for medical, physiological, or psychological illness or injury.

Emergency Shelter Facilities used solely for out-of-home placement on a short-term basis during periods or sudden emergency, pending formulation or long-term solutions.

Employee Retirement Income Security Act (ERISA)

A federal act, passed in 1974, that established new standards and reporting/disclosure requirements for employer-funded pension and health benefit programs.

Employer Name The name of the employer identified as the group policyholder.

Employer Type The category of the employer as expressed using standard industry codes.

Epidemic A group of cases of a specific disease or illness clearly in excess of what one would normally expect in a particular geographic area. There is no absolute criterion for using the term epidemic; as standards and expectations change, so might the definition of an epidemic (e.g., an epidemic of violence).

Epidemiology The study of the patterns of determinants and antecedents of disease in human populations. It utilizes biology, clinical medicine, and statistics in an effort to understand the etiology (causes) of illness and/or disease. The ultimate goal of the epidemiologist is not merely to identify underlying causes of a disease but to apply findings to disease prevention and health promotion.

Escort Services (Also called transportation services.) Provides transportation for older adults to services and appointments. May use bus, taxi, volunteer drivers, or

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van services that can accommodate wheelchairs and persons with other special needs.

Estimated Liability Costs

Approximate calculations of expenses for damages to which a nursing home is exposed. Because estimates re derived from information provided by nursing homes and the cost of settlements of lawsuits is confidential information known only to the insurance carrier, plaintiff's attorney and defense attorney, these calculations are only estimates and are subject to change.

Evidence-Based Decision Making

In a health policy context, evidence-based decision making is the application of the best available scientific evidence to policy decisions about specific medical treatments or changes in the delivery system. The goals of evidence-based decision making are to improve the quality of care, increase the efficiency of care delivery, and improve the allocation of health care resources.

Evidence-Based Medicine

Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. This approach must balance the best external evidence with the desires of the patient and the clinical expertise of health care providers.

Exclusive Provider Arrangement (EPA)

An indemnity or service plan that provides benefits only if care is rendered by the institutional and professional providers with which it contracts (with exceptions for emergency and out-of-area services).

Experience Rating A method of adjusting health plan premiums based on the historical utilization data and distinguishing characteristics of a specific subscriber group.

Family and Medical Leave Act (FMLA)

A 1993 federal law requiring employers with more than 50 employees to provide eligible workers up to 12 weeks of unpaid leave for birth, adoptions, foster care placement, and illnesses of employees and their families.

Family Foster Home Non-secure, 24-hour, residential care in a permanent or temporary family setting (include adoptive placements that have not yet been finalized, and relatives only if they are licensed or reimbursed).

Family Practice A form of specialty practice in which physicians provide continuing comprehensive primary care within the context of the family unit.

Federal Employees Health Benefits Program (FEHBP)

A voluntary health insurance subsidy program administered by the Office of Personnel Management for civilian employees (including retirees and dependents) of the Federal Government. Enrollees select from a number of approved plans, the costs of which are primarily borne by the government.

Federal Poverty The amount of income determined by the federal

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Level (FPL) Department of Health and Human Services to provide a bare minimum for food, clothing, transportation, shelter, and other necessities. FPL is reported annually and varies according to family size (e.g., for a family of three in 1999, the FPL was $13,880, or $1,157 per month). Public assistance programs usually define income limits in relation to FPL.

Fee Schedule A list of physician services in which each entry is associated with a specific monetary amount that represents the approved payment level for a given insurance plan.

Fee-For-Service (FFS) Method of billing for health services under which a physician or other practitioner charges separately for each patient encounter or service rendered; it is the method of billing used by the majority of U.S. physicians. Under a fee-for-service payment system, expenditures increase if the fees themselves increase, if more units of service are provided, or if more expensive services are substituted for less expensive ones. This system contrasts with salary, per capita, or other prepayment systems, where the payment to the physician is not changed with the number of services actually used.

Fiduciary Relating to, or founded upon, a trust or confidence. A fiduciary relationship exists where an individual or organization has an explicit or implicit obligation to act in behalf of another person's or organization's interests in matters that affect the other person or organization. A physician has such a relation with his/her patient, and a hospital trustee has one with a hospital.

For-Profit Organization or company in which profits are distributed to shareholders or private owners.

Formulary A list of drugs, usually by their generic names, and indications for their use. A formulary is intended to include a sufficient range of medicines to enable physicians, dentists, and, as appropriate, other practitioners to prescribe all medically appropriate treatment for all reasonably common illnesses. An "open" formulary allows a coverage for almost all drugs. A "closed" formulary provides coverage for a limited set of drugs. A "managed" formulary includes a list of preferred drugs that the health plan prefers to use because they cost less, are more effective, or for other reasons. A "tiered" formulary financially rewards patients for using generic and formulary drugs by requiring the patient to pay progressively higher copayments for brand-name and non-formulary drugs. For example, in a three-tiered benefit structure, copayments may be $5 for a generic, $10 for a formulary brand product, and $25 for a non-formulary

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brand product.Foster Care Any of the following out-of-home placements under the

jurisdiction of the primary state child welfare agency and regarded as 24-hour substitute care, not including finalized adaptive home placements, placement with relatives who are not licensed or reimbursed, or placement made by state agencies other than the primary child welfare agency: family foster home, group home, group home 21+, emergency shelter, secure facility, independent living, parents or relative.

Foster Child Any child in public foster care, or in private foster care but under the case management and planning responsibility of the primary state child welfare agency, who is 0-17 years old, or 18,19, or 20 years old and entered foster care before age 18.

Foundation for Accountability (FACCT)

FACCT is a not-for-profit organization dedicated to helping Americans make better health care decisions. FACCT's board of trustees is made up of consumer organizations and purchasers of health care services and insurance representing 80 million Americans. FACCT creates tools that help people understand and use quality information, develops consumer-focused quality measures, supports public education about health care quality, supports efforts to gather and provide quality information, and encourages health policy to empower and inform consumers.

Frequency of Future Purchase Option

Indicates whether the FPO is made on an annual basis, or on a frequency less often than that (e.g., every two or three years).

Functionally Disabled A person with a physical or mental impairment that limits the individual's capacity for independent living.

Gatekeeper The primary care practitioner in managed care organizations who determines whether the presenting patient needs to see a specialist or requires other non-routine services. The goal is to guide the patient to appropriate services while avoiding unnecessary and costly referrals to specialists.

General Liability Claims/Losses

Amounts a nursing home liability insurer is legally obligated to pay as damages to a plaintiff due to bodily injury or property damage.

General Practice A form of practice in which physicians without specialty training provide a wide range of primary health care services to patients.

Generic Substitution In cases in which the patent on a specific pharmaceutical product expires and drug manufacturers produce generic versions of the original branded product, the generic version of the drug (which is theorized to be identical to the product manufactured by a different firm) is dispensed even though the

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original product is prescribed. Some managed care organizations and Medicaid programs mandate generic substitution because of the generally lower cost of generic products. There are state and federal regulations regarding generic substitutions.

Genomics The study of genomes, which includes gene mapping, gene sequencing, and gene function.

Geriatrician Physician who is certified in the care of older people.Geriatrics Medical specialty focusing on treatment of health

problems of the elderly.Gerontology Study of the biological, psychological and social

processes of aging.Graduate Medical Education (GME)

Medical education after receipt of the Doctor of Medicine (MD) or equivalent degree, including the education received as an intern, resident (which involves training in a specialty), or fellow, as well as continuing medical education. CMS partly finances GME through Medicare direct and indirect payments.

Adult Care Home (Also called adult care home or board and care home.) Residence which offers housing and personal care services for 3 to 16 residents. Services (such as meals, supervision, and transportation) are usually provided by the owner or manager. May be single family home. (Licensed as adult family home or adult group home.)

Group Home (Also called shelter or half-way house.) Non-secure, 24-hour residential care facility serving up to 20 persons which provides nonspecialized physical care and may or not offer an educational program on site.

Group Home 21+ (Also called residential treatment facility or child care institution.) Non-secure, 24-hour, residential care facility serving 21 or more persons which provides nonspecialized physical care and may or may not offer a therapeutic service or an educational program for emotionally disturbed or otherwise handicapped youth.

Guardian A judicially appointed guardian or conservator having authority to make a health care decision for an individual.

Handicapped As defined by Section 504 of the Rehabilitation Act of 1973, any person who has a physical or mental impairment which substantially limits one or more major life activity, has a record of such impairment, or is regarded as having such an impairment. Those individuals diagnosed as having a handicapping condition in accordance with the following definitions: mentally retarded; seriously emotionally disturbed; specific learning disability; hearing, speech, or sight impaired; physical or health handicapped. Persons

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should not be counted as handicapped unless they have been clinically diagnosed as having these conditions. Use one primary diagnosis for multiply handicapped children.

Health The state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. It is recognized, however, that health has many dimensions (anatomical, physiological, and mental) and is largely culturally defined. The relative importance of various disabilities will differ depending upon the cultural milieu and the role of the affected individual in that culture. Most attempts at measurement have been assessed in terms or morbidity and mortality.

Health Care Paraprofessional

Home health aides, certified nurse aids, and personal care attendants who provide direct care and personal support services in hospitals, nursing homes, other institutions, as well as home-based care to the disabled, aged, and infirm.

Health Education Any combination of learning opportunities designed to facilitate voluntary adaptations of behavior (in individuals, groups, or communities) conducive to health.

Health Facilities Collectively, all physical plants used in the provision of health services--usually limited to facilities that were built for the purpose of providing health care, such as hospitals and nursing homes. They do not include an office building that includes a physician's office. Health facility classifications include: hospitals (both general and specialty), long-term care facilities, kidney dialysis treatment centers, and ambulatory surgical facilities.

Health Insurance Financial protection against the medical care costs arising from disease or accidental bodily injury. Such insurance usually covers all or part of the medical costs of treating the disease or injury. Insurance may be obtained on either an individual or a group basis.

Health Insurance Flexibility and Accountability (HIFA)

The primary goal of the HIFA demonstration initiative is to encourage new comprehensive state approaches that will increase the number of individuals with health insurance coverage within current level Medicaid and State Children's Health Insurance Program (SCHIP) resources. The program utilizes CMS Section 1115 waiver authority and emphasizes broad statewide approaches that maximize private health insurance coverage options and target Medicaid and SCHIP resources to populations with incomes below 200% of the federal poverty level.

Health Insurance Portability and Accountability Act

Federal health insurance legislation passed in 1996, which sets standards for access, portability, and renewability that apply to group coverage--both fully

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(HIPAA) insured and self-funded--as well as to individual coverage. HIPAA allows under specified conditions, for long-term care insurance policies to be qualified for certain tax benefits under Section 7702(b) of the Internal Revenue Code.

Health Insurance Purchasing Cooperative (HIPC)

Public or private organization that secures health insurance coverage for the workers of all member employers. The goal of these organizations is to consolidate purchasing responsibilities to obtain greater bargaining clout with health insurers, plans and providers to reduce the administrative costs of buying, selling, and managing insurance policies. Private cooperatives are usually voluntary associations of employers in a similar geographic region who band together to purchase insurance for their employees. Public cooperatives are established by state governments to purchase insurance for public employees, Medicaid beneficiaries, and other designated populations.

Health Maintenance Organization (HMO)

Managed care organization that offers a range of health services to its members for a set rate, but which requires its members to use health care professionals who are part of its network of providers. (See also Medicare HMOs.)

Health Manpower Shortage Area (HMSA)

An area or group which HHS designates as having an inadequate supply of health care providers. HMSAs can include: (1) an urban or rural geographic area, (2) a population group for which access barriers can be demonstrated to prevent members of the group from using local providers, or (3) medium and maximum-security correctional institutions and public or nonprofit private residential facilities.

Health Personnel Collectively, all persons working in the provision of health services, whether as individual practitioners or employees of health institutions and program, whether or not professionally trained, and whether or not subject to public regulation. Facilities and health personnel are the principal health resources used in producing health services.

Health Plan An organization that provides a defined set of benefits. This term usually refers to an HMO-like entity, as opposed to an indemnity insurer.

Health Planning Planning concerned with improving health, whether undertaken comprehensively for a whole community or for a particular population, type of health service, institution, or health program. The components of health planning include: data assembly and analysis, goal determination, action recommendation, and implementation strategy.

Health Policy An insurance contract consisting of a defined set of

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benefits. See health insurance.Health Risk Factors Chemical, psychological, physiological, or genetic

factors and conditions that predispose an individual to the development of a disease.

Health Services Research

Health services research is the multi-disciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations.

Health Status The state of health of a specified individual, group, or population. It may be measured by obtaining proxies such as people's subjective assessments of their health; by one or more indicators of mortality and morbidity in the population, such as longevity or maternal and infant mortality; or by using the incidence or prevalence of major diseases (communicable, chronic, or nutritional). Conceptually, health status is the proper outcome measure for the effectiveness of a specific population's medical care system, although attempts to relate effects of available medical care to variations in health status have proved difficult.

Health Systems Agency (HSA)

A health planning agency created under the National Health Planning and Resources Development Act of 1974. HSAs were usually nonprofit private organizations and served defined health service areas as designated by the states.

Health Technology Assessment (HTA)

The systematic evaluation of properties, effects, or other impacts of health care technology. HTA is intended to inform decision-makers about health technologies and may measure the direct or indirect consequences of a given technology or treatment.

Healthcare Cost and Utilization Project Quality Indicators (HCUP QIs)

HCUP QIs comprise a set of 33 clinical performance measures that inform hospitals' self-assessments of inpatient quality of care, as well as state and community assessments of access to primary care. Developed by the Agency for Healthcare Research and Quality as a quick and easy-to-use screening tool, HCUP QIs are intended as a starting point in identifying clinical areas appropriate for further, more in-depth study and analysis. HCUP QIs span three dimensions of care: (1) potentially avoidable adverse hospital outcomes; (2) potentially inappropriate utilization of hospital procedures; and, (3) potentially avoidable hospital admissions.

High-Risk Pool A subsidized health insurance pool organized by some states as an alternative for individuals who have been

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denied health insurance because of a medical condition, or whose premiums are rated significantly higher than the average due to health status or claims experience. Commonly operated through an association composed of all health insurers in a state. HIPAA allows states to use high-risk pools as an "acceptable alternative mechanism" that satisfies the statutory requirements for ensuring access to health insurance coverage for certain individuals.

Hill-Burton Act Coined from the names of the principal sponsors of the Public Law 79-725 (the Hospital Survey and Construction Act of 1946). This program provided federal support for the construction and modernization of hospitals and other health facilities. Hospitals that have received Hill-Burton funds incur an obligation to provide a certain amount of charity care.

Hindsight Bias A bias in investigating the cause of a medical error or accident where in retrospect the reviewer simplifies the cause of the error to a single element, overlooking multiple contributing factors. The hindsight bias makes it easy to arrive at a simple solution or to blame an individual, but often makes it difficult to determine the true cause(s) of the error or propose systematic solutions.

Holism Refers to the integration of mind, body, and spirit of a person and emphasizes the importance of perceiving the individual (regarding physical symptoms) in a "whole" sense. Holism teaches that the health care system must extend its focus beyond solely the physical aspects of disease and particular organ in question, to concern itself with the whole person and the interrelationships between the emotional, social, spiritual, as well as physical implications of disease and health.

Home and Community-Based Services (HCBS)

Any care or services provided in a patient's place of residence or in a non-institutional setting located in the immediate community. HCBS may include home health care, adult day care or day treatment, medical services, or other interventions provided for the purpose of allowing a patient to receive care at home or in their community.

Home and Community-Based Waivers

Section 2176 of the Omnibus Reconciliation Act permits states to offer, under a waiver, a wide array of home and community-based services that an individual may need to avoid institutionalization. Regulations to implement the act list the following services as community and home-based services which may be offered under the waiver program: case management, homemaker, home health aide, personal care, adult day health care, habilitation, respite care and other

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services.Home Health Services provided at a patient's place of residence

(typically a patient's home), in compliance with a physician's written plan of care that is reviewed every 62 days--including nursing services, as defined in the State Nurse Practice Act, home health aide services, physical therapy, occupational therapy or speech pathology, and audiology services--that are provided by a home health agency or by a facility licensed by the state to provide these medical rehabilitation services.

Home Health Agency (HHA)

A public or private organization that provides home health services supervised by a licensed health professional in the patient's home either directly or through arrangements with other organizations.

Home Health Aide A person who, under the supervision of a home health or social service agency, assists elderly, ill or disabled person with household chores, bathing, personal care, and other daily living needs. Social service agency personnel are sometimes called personal care aides.

Home Health Care Includes a wide range of health-related services such as assistance with medications, wound care, intravenous (IV) therapy, and help with basic needs such as bathing, dressing, mobility, etc., which are delivered at a person's home.Health services rendered in the home to the aged, disabled, sick, or convalescent individuals who do not need institutional care. The services may be provided by a visiting nurse association, home health agency, country public health department, hospital, or other organized community group and may be specialized or comprehensive. The most common types of home health care are the following--nursing services; speech, physical, occupational and rehabilitation therapy; homemaker services; and social services.

Home Health Care Benefit Amount

The maximum amount which the policy or certificate will pay for care received at home (or for home and other community care benefits). If the benefit is paid as weekly or monthly, the daily amount should be derived by whatever convention is most appropriate for the carrier to use. The data should be the current amount on the policy in order to account both for any voluntary increases in coverage the insured has elected or any automatic coverage increases as a result of inflation protection.

Home Medical Equipment

(Also called durable medical equipment.) Equipment such as hospital beds, wheelchairs, and prosthetics used at home. May be covered by Medicaid and in part by Medicare or private insurance.

Homebound One of the requirements to qualify for Medicare home health care. Means that someone is generally unable to

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leave the house, and if they do leave home, it is only for a short time (e.g., for a medical appointment) and requires much effort.

Homemaker Services In-home help with meal preparation, shopping, light housekeeping, money management, personal hygiene and grooming, and laundry.

Horizontal Integration

Merging of two or more firms at the same level of production in some formal, legal relationship.

Hospice A program which provides palliative and supportive care for terminally ill patients and their families, either directly or on a consulting basis with the patient's physician or another community agency. The whole family is considered the unit of care, and care extends through their period of mourning.

Hospice Care Services for the terminally ill provided in the home, a hospital, or a long-term care facility. Includes home health services, volunteer support, grief counseling, and pain management.

Hospital An institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and nonsurgical.

Impairment Any loss or abnormality of psychological, physiological, or anatomical function.

Independent Living Facility

Rental units in which services are not included as part of the rent, although services may be available on site and may be purchased by residents for an additional fee.A facility (house, apartment, etc.) in which a child/youth is permitted to live or reside "independently" without a paid caretaker.

Indigent Care Health services provided to the poor or those unable to pay. Since many indigent patients are not eligible for federal or state programs, the costs which are covered by Medicaid are generally recorded separately from indigent care costs.

Indirect Cost Cost which cannot be identified directly with a particular activity, service or product of the program experiencing the cost. Indirect costs are usually apportioned among the program's services in proportion to each service's share of direct costs.

Individual Instruction An individual's direction concerning a health care decision. This may be written or verbal describing goals for health care, treatment preferences, or willingness to tolerate future health states.

Inpatient A person who has been admitted at least overnight to a hospital or other health facility (which is therefore responsible for his or her room and board) for the purpose of receiving diagnostic treatment or other health services.

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Institutional Health Services

Health services delivered on an inpatient basis in hospitals, nursing homes, or other inpatient institutions. The term may also refer to services delivered on an outpatient basis by departments or other organizational units of, or sponsored by, such institutions.

Institutional Long-Term Care (ILTC)

Nursing facility services, services provided in ICFs/MR, mental hospital services for people over age 65, and inpatient psychiatric facility services for individuals under age 21.

Instructional Health Care Directive

(Also called a living will.) A written directive describing preferences or goals for health care, or treatment preferences or willingness to tolerate health states, aimed at guiding future health care.

Instrumental Activities of Daily Living (IADLs)

Household/independent living tasks which include using the telephone, taking medications, money management, housework, meal preparation, laundry, and grocery shopping.

Intermediate Care Occasional nursing and rehabilitative care ordered by a doctor and performed or supervised by skilled medical personnel.

Intermediate Care Facility (ICF)

A nursing home, recognized under the Medicaid program, which provides health-related care and services to individuals who do not require acute or skilled nursing care, but who, because of their mental or physical condition, require care and services above the level of room and board available only through facility placement. Specific requirements for ICF's vary by state. Institutions for care of the mentally retarded or people with related conditions (ICF/MR) are also included. The distinction between "health-related care and services" and "room and board" is important since ICF's are subject to different regulations and coverage requirements than institutions which do not provide health-related care and services.

International Classification of Diseases, ninth edition (Clinical Modification) (EXAMPLE- ICD-9-CM)

A list of diagnoses and identifying codes used by physicians and other health care providers. The coding and terminology provide a uniform language that permits consistent communication on claim forms.

Intubation Refers to "endotracheal intubation" the insertion of a tube through the mouth or nose into the trachea (windpipe) to create and maintain an open airway to assist breathing.

Inventory A detailed description of quantities and locations of different kinds of facilities, major equipment, and personnel which are available in a geographic area and the amount, type, and distribution of services these resources can support.

Learning Disability A disorder in one or more of the basic psychological

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processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculation. The term includes such conditions as perceptual handicaps, brain injury, and minimal brain dysfunction.

Level of Care (LOC) Amount of assistance required by consumers which may determine their eligibility for programs and services. Levels include: protective, intermediate, and skilled.

Level of Care Criteria Guidelines employed to assist in determining the appropriate setting and intensity of behavioral health treatment.

License/Licensure A permission granted to an individual or organization by a competent authority, usually public, to engage lawfully in a practice, occupation, or activity.

Life-Sustaining Treatment

Medical procedures that replace or support an essential bodily function. Life-sustaining treatments include CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, and certain other treatments.

Long-Term Care (LTC)

Range of medical and/or social services designed to help people who have disabilities or chronic care needs. Services may be short- or long-term and may be provided in a person's home, in the community, or in residential facilities (e.g., nursing homes or assisted living facilities).

Long-Term Care Insurance (LTCI)

Insurance policies which pay for long-term care services (such as nursing home and home care) that Medicare and Medigap policies do not cover. Policies vary in terms of what they will cover, and may be expensive. Coverage may be denied based on health status or age.

Long-Term Care Ombudsman

An individual designated by a state or a sub-state unit responsible for investigating and resolving complaints made by or for older people in long-term care facilities. Also responsible for monitoring federal and state policies that relate to long-term care facilities, for providing information to the public about the problems of older people in facilities, and for training volunteers to help in the ombudsman program. The long-term care ombudsman program is authorized by Title III of the Older Americans Act.

Managed Care (MC) Method of organizing and financing health care services which emphasizes cost-effectiveness and coordination of care. Managed care organizations (including HMOs, PPOs, and PSOs) receive a fixed amount of money per client/member per month (called a capitation), no matter how much care a member needs during that month. Payment mechanism used to manage health care, including services provided by health maintenance organizations or Programs of All-Inclusive

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Care for the Elderly, prepaid health plans, and primary care case management plans.

Mechanical Ventilation

Treatment in which a mechanical ventilator supports or replaces the function of the lungs. The ventilator is attached to a tube inserted in the nose or mouth and down into the windpipe (or trachea). Mechanical ventilation often is used to assist a person through a short-term problem or for prolonged periods in which irreversible respiratory failure exists due to injuries to the upper spinal cord or a progressive neurological disease.

Medicaid (Title XIX) Federal and state-funded program of medical assistance to low-income individuals of all ages. There are income eligibility requirements for Medicaid.

Medicaid Federal and state-funded program of medical assistance to low-income individuals of all ages. There are income eligibility requirements for Medicaid.

Medical Necessity Services or supplies which are appropriate and consistent with the diagnosis in accord with accepted standards of community practice and are not considered experimental. They also cannot be omitted without adversely affecting the individual's condition or the quality of medical care.

Medically Indigent People who cannot afford needed health care because of insufficient income and/or lack of adequate health insurance.

Medicare Federal health insurance program for persons age 65 and over (and certain disabled persons under age 65). Consists of 2 parts: Part A (hospital insurance) and Part B (optional medical insurance which covers physicians' services and outpatient care in part and which requires beneficiaries to pay a monthly premium).

Medicare Supplement Insurance (MedSupp)

(Also called Medigap.) Insurance supplement to Medicare that is designed to fill in the "gaps" left by Medicare (such as co-payments). May pay for some limited long-term care expenses, depending on the benefits package purchased.

Medigap (Also called Medicare supplement insurance. Insurance supplement to Medicare that is designed to fill in the "gaps" left by Medicare (such as co-payments). May pay for some limited long-term care expenses, depending on the benefits package purchased.

Mental Health The capacity in an individual to function effectively in society. Mental health is a concept influenced by biological, environmental, emotional, and cultural factors and is highly variable in definition, depending on time and place. It is often defined in practice as the absence of any identifiable or significant mental

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disorder and sometimes improperly used as a synonym for mental illness.

Mental Health Services

Variety of services provided to people of all ages, including counseling, psychotherapy, psychiatric services, crisis intervention, and support groups. Issues addressed include depression, grief, anxiety, stress, as well as severe mental illnesses.

Mental Illness/Impairment

A deficiency in the ability to think, perceive, reason, or remember, resulting in loss of the ability to take care of one's daily living needs.

Mentally Retarded Significantly sub-average general intellectual functioning (specifically an I.Q. below 70) existing concurrently with deficits in adaptive behavior manifested during the developmental period (age 0-21).

Minimally Conscious State

A neurological state characterized by inconsistent but clearly discernible behavioral evidence of consciousness and distinguishable from coma and a vegetative state by documenting the presence of specific behavioral features not found in either of these conditions. Patients may evolve to the minimally conscious state from coma or a vegetative state after acute brain injury, or it may result from degenerative or congenital nervous system disorders. This condition is often transient but may exist as a permanent outcome.

Morbidity The extent of illness, injury, or disability in a defined population. It is usually expressed in general or specific rates of incidence or prevalence.

Mortality Death. Used to describe the relation of deaths to the population in which they occur.

Nonprofit/Not-For-Profit

An organization that reinvests all profits back into that organization.

Nurse An individual trained to care for the sick, aged, or injured. Can be defined as a professional qualified by education and authorized by law to practice nursing.

Nurse Practitioner (NP)

A registered nurse working in an expanded nursing role, usually with a focus on meeting primary health care needs. NPs conduct physical examinations, interpret laboratory results, select plans of treatment, identify medication requirements, and perform certain medical management activities for selected health conditions. Some NPs specialize in geriatric care.

Nursing Home Facility licensed by the state to offer residents personal care as well as skilled nursing care on a 24 hour a day basis. Provides nursing care, personal care, room and board, supervision, medication, therapies and rehabilitation. Rooms are often shared, and communal dining is common. (Licensed as nursing homes, county homes, or nursing homes/residential care facilities.)

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Nursing Home Benefit Amount

The maximum amount which the policy or certificate will pay for care received in a nursing home. If the benefit is paid as weekly or monthly, the daily amount should be derived by whatever convention is most appropriate for the carrier to use. The data should be the current amount on the policy in order to account both for any voluntary increases in coverage the insured has elected or any automatic coverage increases as a result of inflation protection.

Nursing Home Benefits Paid During Reporting Period

The total amount of benefits paid during the reporting period for care in a nursing home or in a similar covered care institutional setting as defined as "nursing home" or "facility-based" care within the policy or certificate.

Nursing Home Care Full-time care delivered in a facility designed for recovery from a hospital, treatment, or assistance with common daily activities.

Occupancy Rate A measure of inpatient health facility use, determined by dividing available bed days by patient days. It measures the average percentage of a hospital's beds occupied and may be institution-wide or specific for one department or service.

Occupational Health Services

Health services concerned with the physical, mental, and social well-being of an individual in relation to his or her working environment and with the adjustment of individuals to their work. The term applies to more than the safety of the workplace and includes health and job satisfaction.

Occupational Therapy (OT)

Designed to help patients improve their independence with activities of daily living through rehabilitation, exercises, and the use of assistive devices. May be covered in part by Medicare.

Offshore Captives Captives located outside the United States. The most popular host states for offshore captives include Bermuda, Guernsey and the Cayman Islands.

Older Americans Act (OAA)

Federal legislation that specifically addresses the needs of older adults in the United States. Provides some funding for aging services (such as home-delivered meals, congregate meals, senior center, and employment programs). Creates the structure of federal, state, and local agencies that oversee aging services programs. (See also Title III services.)

Ombudsman A representative of a public agency or a private nonprofit organization who investigates and resolves complaints made by or on behalf of older individuals who are residents of long-term care facilities.

Omnibus Budget Reconciliation Act (OBRA) of 1993

Federal legislation that limits the amount of compensation that can be paid to employees covered by long-term disability plans funded through voluntary employees' beneficiary association trusts. Any such

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plan with participants earning more than $150,000 could lose its tax-exempt status.

Outpatient A patient who is receiving ambulatory care at a hospital or other facility without being admitted to the facility. Usually, it does not mean people receiving services from a physician's office or other program which also does not provide inpatient care.

Palliative Care (Also called comfort care.) A comprehensive approach to treating serious illness that focuses on the physical, psychological, and spiritual needs of the patient. Its goal is to achieve the best quality of life available to the patient by relieving suffering, controlling pain and symptoms, and enabling the patient to achieve maximum functional capacity. Respect for the patient's culture, beliefs, and values is an essential component.

Parents or Relatives (Also referred to as own home). Return of the child to parental or non-licensed/reimbursed relative's home, with ongoing assistance and/or supervision provided.

Permanent Vegetative State (PVS)

A vegetative state is a clinical condition of complete unawareness of the self and the environment accompanied by sleep-wake cycles with either complete or partial preservation of hypothalamic and brainstem autonomic functions. The PVS is a vegetative state present at one month after acute traumatic or non-traumatic brain injury, and present for at least one month in degenerative/metabolic disorders or developmental malformations. A PVS can be diagnosed on clinical grounds with a high degree of medical certainty in most adult and pediatric patients after careful, repeated neurologic examinations by a physician competent in neurologic function assessment and diagnosis. A PVS patient becomes permanently vegetative when the diagnosis of irreversibility can be established with a high degree of clinical certainty (i.e., when the chance of regaining consciousness is exceedingly rare).

Personal Care (Also called custodial care.) Assistance with activities of daily living as well as with self-administration of medications and preparing special diets.Personal services such as bathing and toileting, sometimes expanded to include light housekeeping furnished to an individual who is not an inpatient or a resident of a group home, assisted living facility, or long-term facility such as a hospital, nursing facility, ICF/MR, or institution for mental disease. Personal care services are those that individuals would typically accomplish themselves if they did not have a disability.

Physical Therapy (PT) Designed to restore/improve movement and strength in people whose mobility has been impaired by injury and disease. May include exercise, massage, water therapy,

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and assistive devices. May be covered in part by Medicare.

Physician Assistant (PA)

(Also known as a physician extender.) A specially trained and licensed or otherwise credentialed individual who performs tasks, which might otherwise be performed by a physician, under the direction of a supervising physician.

Post-Acute Care (PAC)

(Also called subacute care or transitional care.) Type of short-term care provided by many long-term care facilities and hospitals which may include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between the hospital and home. Residents on these units often have been hospitalized recently and typically have more complicated medical needs. The goal of subacute care is to discharge residents to their homes or to a lower level of care.

Pre-Admission Certification

A process under which admission to a health institution is reviewed in advance to determine need and appropriateness and to authorize a length of stay consistent with norms for the evaluation.

Preferred Provider Arrangement (PPA)

Selective contracting with a limited number of health care providers, often at reduced or pre-negotiated rates of payment

Preferred Provider Organization (PPO)

Managed care organization that operates in a similar manner to an HMO or Medicare HMO except that this type of plan has a larger provider network and does not require members to receive approval from their primary care physician before seeing a specialist. It is also possible to use doctors outside the network, although there may be a higher co-payment.

Premium The periodic payment (e.g., monthly, quarterly) required to keep an insurance policy in force.The charge paid by a policyholder for insurance coverage.

Prepayment Usually refers to any payment to a provider for anticipated services (such as an expectant mother paying in advance for maternity care).

Preventive Medicine Care which has the aim of preventing disease or its consequences. It includes health care programs aimed at warding off illnesses (e.g., immunizations), early detection of disease (e.g., Pap smears), and inhibiting further deterioration of the body (e.g., exercise or prophylactic surgery). Preventive medicine is also concerned with general prevention measures aimed at improving the healthfulness of the environment.

Primary Care Basic or general health care focused on the point at which a patient ideally first seeks assistance from the medical care system.

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Private Duty Nursing Services, except those for mental health or substance abuse treatment, provided by registered nurses or licensed practical nurses under direction of a physician to recipients in their own homes, hospitals, or nursing facilities as specified by the state.

Program of All-Inclusive Care for the Elderly (PACE)

A managed care plan that coordinates Medicare and Medicaid acute care and long-term care for dual eligible enrollees (those age 55 and older, living in a PACE area, and otherwise eligible for nursing home care). A capitated payment mechanism is used for PACE plan enrollees.

Prospective Payment Any method of paying hospitals or other health programs in which amounts or rates of payment are established in advance for a defined period (usually a year).

Provider Individual or organization that provides health care or long-term care services (e.g., doctors, hospital, physical therapists, home health aides, and more).

Provider Sponsored Organization (PSO)

Managed care organization that is similar to an HMO or Medicare HMO except that the organization is owned by the providers in that plan and these providers share the financial risk assumed by the organization.

Psychiatric Rehabilitation Option

An optional Medicaid service that can include (depending on state definitions) community support programs, school-based services, crisis intervention services, and outpatient psychotherapy services.

Public Health The science dealing with the protection and improvement of community health by organized community effort.

Punitive Damages Civil litigation means monetary compensation awarded by a judge or jury which exceeds the losses suffered by the injured party in order to punish the defendant.

Qualifying Condition The specific conditions for which the individual qualifies as chronically ill. This could include dependency in the required number of ADLs, cognitive impairment or both.

Quality of Care Can be defined as a measure of the degree to which delivered health services meet established professional standards and judgments of value to the consumer.

Ratio Adjustment Potentially biased indirect state-level estimates can be ratio adjusted to regional totals so that the sum across states matches regional estimates. This eliminates bias at the regional level and attempts to remove bias from the state-level indirect estimator.

Re-insurance The practice of insurance carriers ceding risk to other firms, called re-insurance companies, in order to limit their liability exposure. Re-insurance companies essentially provide insurance to insurance companies. Instead of assessing the risk of individual policyholders, re-insurance companies assess risk on a broader scale, such as on the basis of a particular product-line

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(nursing home liability insurance) or a geographic region.

Registered Nurse (RN)

A nurse who has graduated from a formal program of nursing education and has been licensed by an appropriate state authority. RNs are the most highly educated of nurses with the widest scope of responsibility, including all aspects of nursing care. RNs can be graduated from one of three educational programs: two-year associate degree program, three-year hospital diploma program, or four-year baccalaureate program.

Rehabilitation The combined and coordinated use of medical, social, educational, and vocational measures for training or retaining individuals disabled by disease or injury to the highest possible level of functional ability. Several different types of rehabilitation are distinguished: vocational, social, psychological, medical, and educational.

Rehabilitation Services

Services designed to improve/restore a person's functioning; includes physical therapy, occupational therapy, and/or speech therapy. May be provided at home or in long-term care facilities. May be covered in part by Medicare.

Reimbursement The process by which health care providers receive payment for their services. Because of the nature of the health care environment, providers are often reimbursed by third parties who insure and represent patients.

Reinsurance The practice of insurance carriers ceding risk to other firms, called reinsurance companies, in order to limit their liability exposure. Reinsurance companies essentially provide insurance to insurance companies. Instead of assessing the risk of individual policyholders, reinsurance companies assess risk on a broader scale, such as on the basis of a particular product line (nursing home liability insurance) or a geographic region.

Residential Care The provision of room, board and personal care. Residential care falls between the nursing care delivered in skilled and intermediate care facilities and the assistance provided through social services. It can be broadly defined as the provision of 24-hour supervision of individuals who, because of old age or impairments, necessarily need assistance with the activities of daily living.

Respiratory Therapy The diagnostic evaluation, management, and treatment of the care of patients with deficiencies and abnormalities in the cardiopulmonary (heart-lung) system.

Respite Care Service in which trained professionals or volunteers

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come into the home to provide short-term care (from a few hours to a few days) for an older person to allow caregivers some time away from their caregiving role.

Risk Management Service in which trained professionals or volunteers come into the home to provide short-term care (from a few hours to a few days) for an older person to allow caregivers some time away from their caregiving role.

Risk Management Program

A structured approach to purposefully limit liability risk. They include systematic efforts to improve and maintain high standards for care quality, but can also include additional management techniques to minimize liability exposure, such as improving written documentation. They are often formalized within the management structure of nursing home providers in the form of Risk Management Committees, and/or a designated Director of Risk Management along with formal Risk Management plans that are implemented and monitored by senior management.

Screening The use of quick procedures to differentiate apparently well persons who have a disease or a high risk of disease from those who probably do not have the disease.

Secondary Care Services provided by medical specialists who generally do not have first contact with patients (e.g., cardiologist, urologists, dermatologists).

Secure Facility (Also called training school, reformatory, detention center, jail, or secure hospital.) Twenty-four hour residential care facility of any size, designed and operated to ensure that all entrances and exits are under the exclusive control of the staff, whether or not the person being detained has freedom of movement within the facility perimeters.

Senility The generalized characterization of progressive decline in mental functioning as a condition of the aging process. Within geriatric medicine, this term has limited meaning and is often substituted for the diagnosis of senile dementia and/or senile psychosis.

Senior Center Provides a variety of on-site programs for older adults including recreation, socialization, congregate meals, and some health services. Usually a good source of information about area programs and services.

Seriously Emotionally Disturbed

A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects daily activities: an inability to learn which cannot be explained by intellectual, sensory, or health factors; an inability to build or maintain satisfactory interpersonal relationships with peers or teachers. Inappropriate types of behavior or feelings under normal circumstances; a general pervasive mood of

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unhappiness of depression or a tendency to develop physical symptoms of fears associated with personal or school problems. The term includes persons who are schizophrenic or autistic. The term does not include persons who are socially maladjusted, unless it is determined that they are also seriously emotionally disturbed.

Service Plan (Also called care plan or treatment plan.) Written document which outlines the types and frequency of the long-term care services that a consumer receives. It may include treatment goals for him or her for a specified time period.

Severity of Illness A risk prediction system to correlate the "seriousness" of a disease in a particular patient with the statistically "expected" outcome (e.g., mortality, morbidity, efficiency of care).

Skilled Care "Higher level" of care (such as injections, catheterizations, and dressing changes) provided by trained medical professionals, including nurses, doctors, and physical therapist.

Skilled Nursing Care Daily nursing and rehabilitative care that can be performed only by or under the supervision of, skilled medical personnel.

Skilled Nursing Facility (SNF)

Facility that is certified by Medicare to provide 24-hour nursing care and rehabilitation services in addition to other medical services. (See also nursing home.)

Social Security Disability Insurance (SSDI)

A system of federally provided payments to eligible workers (and, in some cases, their families) when they are unable to continue working because of a disability. Benefits begin with the sixth full month of disability and continue until the individual is capable of substantial gainful activity.

Special Care Units Long-term care facility units with services specifically for persons with Alzheimer's Disease, dementia, head injuries, or other disorders.

Speech Therapy Designed to help restore speech through exercises. May be covered by Medicare.

Spell A series of months during which a person received Medicaid-covered nursing home services for at least one day of each month and received no such services during the month preceding and following the series.

Spend-Down Medicaid financial eligibility requirements are strict, and may require beneficiaries to spend down/use up assets or income until they reach the eligibility level.

Spousal Impoverishment

Federal regulations preserve some income and assets for the spouse of a nursing home resident whose stay is covered by Medicaid.

Standard Deviation Common measure of dispersion or spread of data about the mean.

Standard Error The most commonly used measure of the precision of

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an estimate. A gauge of how close an estimate is likely to be to the population value in the absence of any bias.

State Unit on Aging Authorized by the Older Americans Act. Each state has an office at the state level which administers the plan for service to the aged and coordinates programs for the aged with other state offices.

Subacute Care (Also called post-acute care or transitional care.) Type of short-term care provided by many long-term care facilities and hospitals which may include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between the hospital and home. Residents on these units often have been hospitalized recently and typically have more complicated medical needs. The goal of subacute care is to discharge residents to their homes or to a lower level of care.

Supplemental Security Income (SSI)

A program of support for low-income aged, blind and disabled persons, established by Title XVI of the Social Security Act. SSI replaced state welfare programs for the aged, blind and disabled in 1972, with a federally administered program, paying a monthly basic benefit nationwide of $284.30 for an individual and $426.40 for a couple in 1983. States may supplement this basic benefit amount.

Support Groups Groups of people who share a common bond (e.g., caregivers) who come together on a regular basis to share problems and experiences. May be sponsored by social service agencies, senior centers, religious organizations, as well as organizations such as the Alzheimer's Association.

Survey An investigation in which information is systematically collected.

Title III Services Services provided to individuals age 60 and older which are funded under Title III of the Older Americans Act. Include: congregate and home-delivered meals, supportive services (e.g., transportation, information and referral, legal assistance, and more), in-home services (e.g., homemaker services, personal care, chore services, and more), and health promotion/disease prevention services (e.g., health screenings, exercise programs, and more). (See also Older Americans Act.)

Title XIX (Medicaid) Federal and state-funded program of medical assistance to low-income individuals of all ages. There are income eligibility requirements for Medicaid.

Title XVIII (Medicare) Federal health insurance program for persons age 65 and over (and certain disabled persons under age 65). Consists of 2 parts: Part A (hospital insurance) and Part

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B (optional medical insurance which covers physicians' services and outpatient care in part and which requires beneficiaries to pay a monthly premium).

Title XX Services (Now known as Social Services Block Grant services.) Grants given to states under the Social Security Act which fund limited amounts of social services for people of all ages (including some in-home services, abuse prevention services, and more).

Transitional Care (Also called subacute care or post-acute care.) Type of short-term care provided by many long-term care facilities and hospitals which may include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between the hospital and home. Residents on these units often have been hospitalized recently and typically have more complicated medical needs. The goal of subacute care is to discharge residents to their homes or to a lower level of care.

Transportation Services

(Also called escort services.) Provides transportation for older adults to services and appointments. May use bus, taxi, volunteer drivers, or van services that can accommodate wheelchairs and persons with other special needs.

Treatment Plan (Also called care plan or service plan.) Written document which outlines the types and frequency of the long-term care services that a consumer receives. It may include treatment goals for him or her for a specified time period.

Uncompensated Care Service provided by physicians and hospitals for which no payment is received from the patient or from third party payers.

Underinsured People with public or private insurance policies that do not cover all necessary medical services, resulting in out-of-pocket expenses that exceed their ability to pay.

Underwriting The process by which an insurer assesses the risk of insuring a particular applicant for coverage. Risk retention groups also underwrite by assessing the risk of accepting a prospective member.

Vital Statistics Statistics relating to births (nationality), deaths (mortality), marriages, health, and disease (morbidity).

Wellness A dynamic state of physical, mental, and social well-being; a way of life which equips the individual to realize the full potential of his or her capabilities and to overcome and compensate for weaknesses; a lifestyle which recognizes the importance of nutrition, physical fitness, stress reduction, and self-responsibility.

Withholding/Withdrawing Treatment

Forgoing or discontinuing life-sustaining measures.

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