An organization retained to provide administrative services, such as utilization review, preauthorization of services, and payment of claims.
Grants to pay for additional services provided to clients who have needs that are in excess of those typically experienced.
A payment for a defined range of services for a defined period of time that may vary with the characteristics of the client. Normally, the capitation payment is expressed as a set amount per member per month. These rates are normally not affected by the number or type of actual services provided to the client.
Payment rates that are based on the characteristics of the client and cover all of a defined range of services for a defined period of time. These rates are normally not affected by the number or type of actual services provided to the client.
Community Services Reimbursement Rate Commission.
The costs incurred by a provider for care that is provided to comply with any regulatory requirements in the staffing or manner of care provided, including: 24-hour overnight awake supervision; and other cost factors related to health and safety that are stated in the care plan required for an individual.
A portion of a bill that is the responsibility of the patient and that applies when certain services are rendered. The amount usually varies by the nature of the service and the amount of the bill. This payment supplements the payment that is made by a third-party payer.
A county-level agency responsible for planning and monitoring services at the local level.
Current Procedural Terminology, fourth edition. A standardized system for numerically encoding health care procedures.
A payment system in which payments are made for individual services provided using a preset fee schedule.
The principal payment system used by DDA. This is the successor to the DDA PPS.
Individuals who are not eligible for Medicaid, but who are eligible for publicly subsidized services.
An independent State of Maryland commission responsible for, among other things, collecting and disseminating data on health practitioner payments.
The Federal agency responsible for, among other responsibilities, administering the Medicare and Medicaid programs. Now renamed to Center for Medicare and Medicaid Services (CMS).
An independent State of Maryland commission responsible for setting the rates of the hospitals in Maryland.
A waiver provided to the State by the Federal Government allowing the Medicaid program to pay for services in the patient's home or in the community, rather than requiring that the services be provided in an institutional setting.
The portion of the payment rate that is based on the requirements of the individual client.
The State agency formed by the combination of the Health Care Access and Cost Commission and the Health Resources Planning Commission.
An alternative name for the Medical Assistance Program.
A State-run program that pays for health care and long-term care services to individuals who satisfy certain qualifying criteria, particularly including income limits. This program is jointly funded by the State and Federal Governments.
A Federal program that pays for acute health care services, including but not limited to inpatient hospital, outpatient, and physician services, for elderly or disabled individuals.
A payment system in which the payment rate is established in advance of the provision of services and is not altered based on the actual costs incurred by the provider.
A community-based agency or program funded: by the Developmental Disabilities Administration to serve individuals with developmental disabilities; or by the Mental Hygiene Administration to serve individuals with mental disorders.
The portion of the payment rate that is intended to pay for administrative services and overhead. Specifically, this portion of the payment covers administrative, capital, general, and transportation costs.
The reimbursement rate paid by the Department to a provider from State general funds, Maryland Medical Assistance Program funds, other State or federal funds, or a combination of those funds.
A waiver of Medicaid regulations provided by the U.S. Department of Health and Human Services to a State allowing for a managed care program for all or part of the Medicaid beneficiary population.
The provision of services related to helping a client find work or retain employment.
A plan to alleviate the immediate impact of the change in the payment system by phasing in the impact over a period of time.
Administrative, General, Capital, and Transportation
Administrative Services Organization
Council for Behavioral Health (formerly MAPSS and MCCMHP)
Center for Medicare and Medicaid Services (formerly HCFA)
Current Procedural Terminology, fourth edition
Core Service Agency
Community Services Reimbursement Rate Commission
Developmental Disabilities Administration
Department of Health and Mental Hygiene
Fee Payment System
Health Care Access and Cost Commission
Health Care Financing Administration
Health Services Cost Review Commission
Maryland Association of Community Services
Maryland Association of Psychiatric Support Services
Maryland Council of Community Mental Health Programs, Inc.
Mental Hygiene Administration
Maryland Health Care Commission
Maryland Health Partners
Outpatient Mental Health Clinic
Public Mental Health System
Prospective Payment System
Technical Advisory Group
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464