Acronym Title Description

AAFP AMERICAN ACADEMY OF FAMILY PHYSICIANS

The American Academy of Family Physicians (AAFP) is one of the largest national medical organizations, representing 105,900 family physicians, family medicine residents, and medical students nationwide. Founded in 1947, its mission is to preserve and promote the science and art of family medicine and to ensure high-quality, cost-effective health care for patients of all ages.

AAP AMERICAN ACADEMY OF PEDIATRICSThe mission of the American Academy of Pediatrics (AAP) is to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults.

ACA AFFORDABLE CARE ACT

The Patient Protection and Affordable Care Act, most commonly referred to as the Affordable Care Act (ACA) or federal health care reform, is a federal statute passed by Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. The ACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. It provides a number of mechanisms—including mandates, subsidies, and tax credits—to employers and individuals in order to increase the coverage rate. Additional reforms are aimed at improving healthcare outcomes and streamlining the delivery of health care. The ACA requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or gender. The Congressional Budget Office projected that the ACA will lower future deficits and Medicare spending. On June 28, 2012, the United States Supreme Court upheld the constitutionality of most of the ACA in the case National Federation of Independent Business v. Sebelius.

ACO ACCOUNTABLE CARE ORGANIZATION

An Accountable Care Organization (ACO) is a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers forms an ACO, which then provides care to a group of patients. The ACO may use a range of payment models (capitation, fee-for-service with asymmetric or symmetric shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it."

ACP AMERICIAN COLLEGE OF PHYSICIANS

The American College of Physicians (ACP) is a national organization of internal medicine physicians who specialize in the prevention, detection, and treatment of illnesses in adults. With 130,000 members, ACP is the largest medical-specialty organization and second-largest physician group in the United States. ACP provides information and advocacy for its members as they practice internal medicine and related subspecialties.

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Acronym Title Description

AOA AMERICAN OSTEOPATHIC ASSOCIATION

The American Osteopathic Association (AOA) is the representative member organization for the over 78,000 osteopathic medical physicians (D.O.s) in the United States. The AOA is headquartered in Chicago, Illinois, and is involved in post-graduate training for osteopathic physicians. The organization promotes public health, encourages academic scientific research, serves as the primary certifying body for D.O.s overseeing 18 certifying boards, is the accrediting agency for osteopathic medical schools through its Commission on Osteopathic College Accreditation, and has federal authority to accredit hospitals and other health care facilities,[4][5][6] through its program, the Healthcare Facilities Accreditation Program. The AOA has held yearly conventions since its founding in 1897. The AOA also manages DOCARE International, a non-profit charitable organization. The AOA also publishes The DO, a monthly magazine, and the Journal of the American Osteopathic Association, a peer reviewed medical journal

BHP BASIC HEALTH PROGRAM

The Basic Health Program (BHP) offers an alternative coverage vehicle for individuals at the lower end of the income scale who would otherwise be eligible for tax subsidies for coverage in the Exchange. Individuals may be eligible to enroll in a BHP if they have incomes below 200% FPL, are ineligible for Medicaid, are under age 65, and do not have access to affordable employer- or government-sponsored “minimum essential coverage.” As with tax subsidies, lawfully present immigrants with incomes below 139% FPL may qualify for the BHP if they are ineligible for Medicaid coverage. Significantly, if an individual qualifies for the BHP, he or she may not receive tax subsidies for enrollment in a QHP. The BHP must meet minimum standards related to benefits and cost-sharing. It must cover at least the essential health benefits (EHB) that enrollees would have received had they been enrolled in a QHP through the Exchange. The enrollee’s share of the monthly premium cannot exceed what it would have been had the enrollee purchased the second-lowest cost silver plan (referred to as the benchmark plan). Enrollee cost-sharing cannot exceed the equivalent platinum plan for individuals with incomes below 150% FPL, and the equivalent gold plan for individuals with incomes between 150%-200% FPL, which have actuarial values of 94% and 80%, respectively. If offered by a health insurance issuer, BHP plans must have a medical loss ratio greater than 85%.

CAPG CALIFORNIA ASSOCIATION OF PHYSICIAN GROUPS

The California Association of Physician Groups (CAPG) is the largest association in the country representing physician organizations practicing capitated, coordinated care. CAPG members include more than 160 multi-specialty medical groups and independent practice associations (IPAs) across 20 states. CAPG members provide comprehensive healthcare through coordinated and accountable physician group practices.

CBO CONGRESSIONAL BUDGET OFFICEThe Congressional Budget Office (CBO) is a federal agency within the legislative branch of the United States government that provides economic data to Congress.[1] The CBO was created as a nonpartisan agency by the Congressional Budget and Impoundment Control Act of 1974.

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Acronym Title Description

CCIIO CONSUMER INFORMATION AND INSURANCE OVERSIGHT

The Consumer Information and Insurance Oversight (CCIIO) is charged with helping implement many reforms of the ACA. It oversees the implementation of the provisions related to private health insurance. In particular, CCIIO is working with states to establish new Health Insurance Marketplaces. It also works closely with state regulators, consumers, and other stakeholders to ensure the ACA best serves the American people.

CDC CENTERS FOR DISEASE CONTROL & PREVENTION

The Centers for Disease Control and Prevention (CDC) is a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta.[1][2][3] It works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health departments and other organizations. The CDC focus national attention on developing and applying disease prevention and control (especially infectious diseases and foodborne pathogens and other microbial infections), environmental health, occupational safety and health, health promotion, injury prevention and education activities designed to improve the health of the people of the United States. The CDC is the United States' national public health institute and is a founding member of the International Association of National Public Health Institutes.

CDPH CALIFORNIA DEPARTMENT OF PUBLIC HEALTH

The California Department of Public Health (CDPH) is charged with protecting and promoting the health status of Californians through programs and policies that use population-wide interventions.Health care facilities in California are licensed, regulated, inspected, and/or certified by a number of public and private agencies at the state and federal levels, including the California Department of Public Health (CDPH) Licensing and Certification Program (L&C) and the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS). These agencies have separate -- yet sometimes overlapping -- jurisdictions. L&C is responsible for ensuring health care facilities comply with state laws and regulations. In addition, L&C cooperates with CMS to ensure that facilities accepting Medicare and Medi-Cal (in California, Medicaid is referred to as Medi-Cal) payments meet federal requirements. L&C also oversees the certification of nurse assistants, home health aides, hemodialysis technicians, and the licensing of nursing home administrators.

CHCF CALIFORNIA HEALTH CARE FOUNDATION

Based in Oakland, California, the California Health Care Foundation (CHCF) is an organization that works “as a catalyst to fulfill the promise of better health care for all Californians” by supporting “ideas and innovations that improve quality, increase efficiency, and lower the costs of care.” The Foundation primarily focuses on health care delivery and finance issues in areas such as enhancing the quality of care for the people with chronic diseases; reducing barriers for affordable health care to the underserved; and promoting transparency and accountability in the health care system. Established in 1996, CHCF has more than $750 million in assets and has paid out more than $500 million to support its programmatic work.

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Acronym Title Description

CHIP CHILDREN’S HEALTH INSURANCE PROGRAM

The Children’s Health Insurance Program (CHIP) is a federal-state program that provides health care coverage to children in low- and moderate-income families that earn too much money to qualify for Medicaid, originally called the State Children’s Health Insurance Program (SCHIP). In some states, CHIP covers parents and pregnant women. Each state offers CHIP coverage, and works closely with its state Medicaid program. If the children qualify for CHIP, the parents wont have to bjy a Market place plan to cover them. Parents can apply for and enroll in Medicaid or CHIP any time of year. There is no limited enrollment period for either Medicaid or CHIP.

CMMI CENTER FOR MEDICARE & MEDICAID INNOVATION

The Center for Medicare and Medicaid Innovation (the Innovation Center) was created by Congress via the Affordable Care Act to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits. The Center has organized its Innovation Models into seven categories, which include 1) Accountable care, 2) Bundled Payments for Care Improvement, 3) Primary Care Transformation, 4) Initiatives focused on the Medicaid and CHIP population, 5) Initiatives focused on Medicare-Medicaid Enrollees, 6) Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models and 7) Initiatives to Speed the Adoption of Best Practices

CMS CENTERS FOR MEDICARE & MEDICAID SERVICES

Formed in 1977, the Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid (known as Medi-Cal in California), the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, and clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments.

COBRA CONSOLIDATED OMNIBUS BUDGET RECONSILIATION ACT OF 1986

The COBRA Coverage provides certain former employees, retirees, spouses, former spouses and dependent children the right to temporary continuation of health coverage at group rates.

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Acronym Title Description

DHCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES

The California Department of Health Care Services’ (DHCS) mission is to preserve and improve the health status of all Californians. DHCS works closely with health care professionals, county governments and health plans to provide a health care safety net for California’s low-income and persons with disabilities. DHCS finances and administers a number of individual health care service delivery programs, including the California Medical Assistance Program (Medi-Cal), California Children’s Services program, Child Health and Disability Prevention program and Genetically Handicapped Persons Program. DHCS also helps maintain the financial viability of critical specialized care services, such as burn centers, trauma centers and children’s specialty hospitals. In addition, DHCS funding helps hospitals and clinics located in underserved areas and those serving underserved populations.

DOJ DEPARTMENT OF JUSTICE

The United States Department of Justice (DOJ), also referred to as the Justice Department, is the United States federal executive department responsible for the enforcement of the law and administration of justice, equivalent to the justice or interior ministries of other countries. The Department is led by the Attorney General, who is nominated by the President and confirmed by the Senate and is a member of the Cabinet.

EMA EUROPEAN MEDICINES AGENCY

The European Medicines Agency (EMA) is a European Union agency for the evaluation of medicinal products. From 1995 to 2004, the European Medicines Agency was known as the European Agency for the Evaluation of Medicinal Products, Roughly parallel to the U.S. Food and Drug Administration (FDA), but without FDA-style centralization, the European Medicines Agency was set up in 1995 with funding from the European Union and the pharmaceutical industry, as well as indirect subsidy from member states, in an attempt to harmonize (but not replace) the work of existing national medicine regulatory bodies.

EMR ELECTRONIC MEDICAL RECORD

An Electronic Medical Record (EMR) contains the standard medical and clinical data gathered in one provider’s office. Electronic health records (EHRs) go beyond the data collected in the provider’s office and include a more comprehensive patient history. For example, EHRs are designed to contain and share information from all providers involved in a patient’s care.

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Acronym Title Description

EXCHANGE HEALTH BENEFIT EXCHANGE (CALIFORNIA)

The California Health Benefit Exchange, known as Covered California™ was created to develop an organized marketplace where legal residents of California can buy health coverage that cannot be denied or canceled if an individual is sick or has pre-existing health conditions. All health plans purchased through Covered California must cover a range of services called Essential Health Benefits, and include physician visits, hospitalization, emergency care, maternity care, pediatrics, prescriptions, medical tests, and mental health care. Plans must cover preventive care services like mammograms and colonoscopies with no out-of-pocket cost. All newly sold health plans, whether offered by Covered California or in the private marketplace, will be required to meet these basic requirements. The vision of the California Health Benefit Exchange is to improve the health of all Californians by assuring their access to affordable, high quality care. The mission of the California Health Benefit Exchange is to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.

FDA FOOD & DRUG ADMINISTRATION

The federal Food and Drug Administration (FDA or USFDA) is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments. The FDA is responsible for protecting and promoting public health through the regulation and supervision of food safety, tobacco products, dietary supplements, prescription and over-the-counter pharmaceutical drugs (medications), vaccines, biopharmaceuticals, blood transfusions, medical devices, electromagnetic radiation emitting devices (ERED), and veterinary products.

FEHBP FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM

The Federal Employees Health Benefits Program (FEHBP) is a system of "managed competition" through which employee health benefits are provided to civilian government employees and annuitants of the United States government. The FEHB program allows some insurance companies, employee associations, and labor unions to market health insurance plans to governmental employees. The program is administered by the United States Office of Personnel Management.

FFE FEDERALLY FACILITATED EXCHANGE

The Affordable Care Act aims to increase health insurance coverage primarily through a combination of reforms to health insurance and the health insurance market. Critical to these new arrangements is the creation of health insurance exchanges--marketplaces where people can compare and purchase coverage. There will be two main types of insurance exchanges: one for individuals and their families, and one for small businesses and their employees. Whether an exchange is run by a state, by the federal government, or as a partnership between the two, the law mandates that exchanges fulfill five core functions: eligibility, enrollment, plan management, consumer assistance, and financial management.

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Acronym Title Description

FFS FEE-FOR-SERVICE

Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. Similarly, when patients are shielded from paying (cost-sharing) by health insurance coverage, they are incentivized to welcome any medical service that might do some good. FFS is the dominant physician payment method in the United States,[1] it raises costs, discourages the efficiencies of integrated care, and a variety of reform efforts have been attempted, recommended, or initiated to reduce its influence (such as moving towards bundled payments and capitation). In capitation, physicians are discouraged from performing procedures, including necessary ones, because they are not paid anything extra for performing them. In the Japanese health care system, FFS is mixed with a nationwide price setting mechanism (all payer) to control costs.

FPL FEDERAL POVERTY LEVEL

The Federal Poverty Level (FPL) is the minimum amount of gross income that a family needs for food, clothing, transportation, shelter and other necessities as determined by the US Department of Health and Human Services. FPL varies according to family size. The number is adjusted for inflation and reported annually in the form of poverty guidelines. Public assistance programs, such as Medicaid in the U.S., define eligibility income limits as some percentage of FPL.

FQHC FEDERALLY QUALIFIED HEALTH CENTER

Federally Qualified Health Centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provided comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.

HHS US DEPARTMENT OF HEALTH & HUMAN SERVICES

The United States Department of Health and Human Services (HHS), is a Cabinet department of the United States government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

HIE HEALTH INFORMATION EXCHANGE

Health information exchange (HIE) is the mobilization of healthcare information electronically across organizations within a region, community or hospital system. HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer and more timely, efficient, effective, and equitable patient-centered care. HIE is also useful to public health authorities to assist in analyses of the health of the population.

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Acronym Title Description

HIX HEALTH INSURANCE EXCHANGE

A health insurance exchange (HIX) is a set of government-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies. All exchanges must be fully certified and operational by January 1, 2014, under federal law. HIX (Health Insurance Exchange) is emerging as the de facto acronym across state and federal government stakeholders, and the private sector technology and service providers that are helping states build their exchanges. The acronym HIX differentiates this topic from Health Information Exchange, which has been designated HIE.

HIMTA HEALTHCARE INNOVATION AND MARKETPLACE TECHNOLOGIES ACT

US Congressman Honda introduced H.R. 6626, The Healthcare Innovation and Marketplace Technologies Act (HIMTA), to foster more innovation in the health care industry through the development of marketplace incentives, challenge grants, and increased workforce retraining – all of which will be critical in creating a 21st century healthcare system.

HIT HEALTH INFORMATION TECHNOLOGY

Health Information Technology (HIT), based on broadly accepted standards, allows patients, health care providers and payers (insurance carriers) to share information securely, potentially reducing costs by avoiding duplicate procedures and manual transactions. More importantly, HIT has the potential to reduce medical errors; for instance, from misread, handwritten prescriptions and emergency care medical decisions made without complete and accurate information. Since privacy and security considerations are central to Federal HIT implementation plans, patient records must be protected from inappropriate disclosure.

HRP HIGH-RISK POOL

A high-risk health insurance pool is the most common way to provide individuals with serious pre-existing medical conditions (e.g., cancer, HIV) access to coverage. In addition, in many states, high-risk pools serve as the guanrateed-issue purchasing option for individuals who wish to exercise federal group-to-individual insurance portability rights. High-Risk Pools (HRPs) are also available in many states as a purchasing option for individuals who are eligible for the 65 percent federal health insurance tax credit provided by the Trade Adjustment Assistance Act of 2002. High-risk pools are private, self-funded health insurance plans organized by state to serve high-risk individuals who meet enrollment criteria and do not have access to group insurance. You can apply for high-risk pool coverage through an insurance agent or directly with the state. Once enrolled, you use your benefits just like any other consumer of private insurance coverage.

IAS IMMUNIZATION ACTION COALITION

The Immunization Action Coalition (IAC) works to increase immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public that enhance the delivery of safe and effective immunization services. The Coalition also facilitates communication about the safety, efficacy, and use of vaccines within the broad immunization community of patients, parents, health care organizations, and government health agencies.

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Acronym Title Description

IOM INSTITUTE OF MEDICINE

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Each year, more than 2,000 individuals, members and nonmembers volunteer their time, knowledge and expertise to advance the nation’s health through the work of the IOM. Many of the studies that the IOM undertakes begin as specific mandates from Congress; still others are requested by federal agencies and independent organizations. While its expert, consensus committees are vital to its advisory role, the IOM also convenes a series of forums, roundtables and standing committees, as well as other activities, to facilitate discussion, discovery, and critical, cross-disciplinary thinking.

IPAB INDEPENDENT PAYMENT ADVISORY BOARD

The ACA established the Independent Payment Advisory Board (IPAB) with authority to recommend proposals to limit Medicare spending growth. If projected per capita Medicare spending exceeds target growth rates, the Board is required to recommend proposals to reduce Medicare spending by specified amounts, with the first set of recommendations due in 2014 for implementation in 2015. If the Board fails to submit a proposal, the Secretary of the Department of Health and Human Services is required to develop a detailed proposal to achieve the required level of Medicare savings. The establishment of the Board represents the first time that the Medicare program will be subject to spending limits, with statutory requirements to achieve savings targets. The Board is prohibited from submitting proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase beneficiary premiums and cost-sharing requirements, or reduce low-income subsidies under Part D.

MA MEDICARE ADVANTAGE (PLANS)

A Medicare Advantage (MA) Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide Medicare Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If an individual is enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Medicare Advantage Plans that offer prescription drug coverage are known as MA-PDs.

MACPAC MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION

The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan, federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, and for making recommendations the congress and the Secretary of the U.S. Department of Health and Human Services, and the states on a wide range of issues affecting these programs. Appointed by the U.S. Comptroller General, the 17 commissioners have diverse backgrounds, offer broad perspectives on Medicaid and CHIP, and represent different regions across the United States.

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Acronym Title Description

MEDCAC MEDICARE EVIDENCE DEVELOPMENT & COVERAGE ADVISORY COMMITTEE

The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) was established to provide independent guidance and expert advice to CMS on specific clinical topics. The MEDCAC is used to supplement CMS' internal expertise and to allow an unbiased and current deliberation of "state of the art" technology and science. The MEDCAC reviews and evaluates medical literature, technology assessments, and examines data and information on the effectiveness and appropriateness of medical items and services that are covered under Medicare, or that may be eligible for coverage under Medicare. The MEDCAC judges the strength of the available evidence and makes recommendations to CMS based on that evidence.

MedPAC MEDICARE PAYMENT ADVISORY COMMISSION

The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997. The Commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare. MedPAC produces two major reports to the United States Congress each year that contain recommendations to improve Medicare

MLR MEDICAL LOSS RATIOA Medical Loss Ratio (MLR) is the percentage of health insurance premiums spent by an insurance company on health care services, as opposed to administrative costs or profits.

NAIC NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS

The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. The NAIC’s Consumer Information Source (CIS) provides information about insurance companies you can use BEFORE purchasing insurance. Using the NAIC website and selecting input fields on the CIS page, you can access key information about insurance companies, including closed insurance complaints, licensing information and key financial data.

PCMH PATIENT-CENTERED MEDICAL HOMEThe Patient-Centered Medical Home (PCMH) is a concept in which a patient’s medical care is coordinated by and funneled through a primary care provider, so that all providers caring for that patient work together to avoid redundancy and miscommunication.

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Acronym Title Description

PCORI PATIENT CENTERED OUTCOMES RESEARCH INSTITUTE

The Patient-Centered Outcomes Research Institute (PCORI) was established in 2010 by the ACA.The purpose of the Institute is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis that considers variations in patient subpopulations, and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of those medical treatments, services, and items. It does not have the power to mandate or endorse coverage rules or reimbursement for any particular treatment and Medicare may take the Institute’s research into account when deciding what procedures it will cover, as long as the new research is not the sole justification and the agency allows for public input.

PHR PERSONAL HEALTH RECORD

A Personal Health Record (PHR) is an electronic application used by patients to maintain and manage their health information in a private, secure, and confidential environment. PHRs are: 1) managed by patients; 2) can include information from a variety of sources, including health care providers and patients themselves; 3) can help patients securely and confidentially store and monitor health information, such as diet plans or data from home monitoring systems, as well as patient contact information, diagnosis lists, medication lists, allergy lists, immunization histories, and much more; 4) are separate from, and do not replace, the legal record of any health care provider; 5) are distinct from portals that simply allow patients to view provider information or communicate with providers

QHP QUALIFIED HEALTH PLAN

Under the ACA, starting in 2014, a Qualified Health Plan (QHP) is an insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements. A qualified health plan will have a certification by each Marketplace in which it is sold.

RAC RECOVERY AUDIT CONTRACTORThe Recovery Audit Contractor (RAC), program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments paid to healthcare providers under fee-for-service (FFS) Medicare plans.

SHADAC STATE HEALTH ACCESS DATA ASSISTANCE CENTER

The University of Minnesota's State Health Access Data Assistance Center (SHADAC) is funded by The Robert Wood Johnson Foundation to help states monitor rates of health insurance coverage, understand factors associated with access to care, and to utilize data for implementation of health reform. In addition to providing health policy analysis, SHADAC provides technical assistance to federal agencies that conduct health insurance surveys, and states that conduct their own surveys and/or use data from national surveys. SHADAC’s goal is to help bridge the gap between health insurance data and the policy making process by providing timely and targeted health policy research with a focus on deriving lessons from state variations in policy and outcomes in the national context.

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Acronym Title Description

SIPP SURVEY OF INCOME AND PROGRAM PARTICIPATION

The Survey of Income and Program Participation (SIPP) is conducted by the United States Census Bureau. It is a major continuing survey that is designed to provide information about the economic well-being of the U.S. population and its need for and participation in government assistance programs (e.g., social security, Medicare, Medicaid, food stamps, AFDC). SIPP data are used to measure the effectiveness of government programs, to estimate future costs and coverage for these programs, and to provide improved statistics on the distribution of income in the U.S.

SNP SPECIAL NEEDS PLANThe Special Needs Plan (SNP) is a category of Medicare Advantage plans designed to serve institutionalized beneficiaries, dual-eligible beneficiaries and beneficiaries with chronic conditions.

SSDI SOCIAL SECURITY DISABILITY INSURANCE

The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program. Social Security Disability Insurance (SSDI) pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes. Supplemental Security Income pays benefits based on financial need.

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