Long Term Care Redesign:
Glossary of Terms and Acronyms

ADL- Activities of Daily Living -- tasks essential to maintain basic hygiene and manage self-care, typically including eating, walking, dressing, bathing, and using the bathroom.

Capitation - A method of payment for services in which providers are paid a pre-determined, fixed amount of money per enrolled member per time period, in return for providing contractually agreed upon services to a specifically defined population.

CBLTC - Community Based Long Term Care

CIP - Community Integration Program, a Medicaid-waiver program - CIP-IA is for persons relocated or diverted from DD centers; CIP-IB is for developmentally disabled persons relocated or diverted from nursing homes; CIP II is for elderly and physically disabled persons diverted or relocated from nursing homes to appropriate community settings with the assistance of home and community based care and with continuity of care. Care in the community is financed by MA through a home and community based service waiver.

Co-payment- A contractual provision whereby the member is required to pay a specific charge for a specific service, usually at the time the service is rendered. Usually applies to physician office visits, prescriptions, emergency, or hospital services.

COP/COP-W - Community Options Program -- The long term care community options program screens persons who are at risk of entering a nursing home or state Center for the Developmentally Disabled to determine whether they can be served by noninstitutional, community-based services. The program provides for both assessment of persons to determine if community-based services are appropriate and funding for eligible, low-income persons to obtain those services necessary to remain at home or in the community. COP is funded solely by state general purpose revenues; the COP waiver program utilizes state/federal Medicaid funding.

DHFS - Department of Health and Family Services

Divestment - In reference to eligibility for Medicaid, the disposal of resources at less than fair market value in order to qualify for benefits.

Health Maintenance Organization (HMO)- A term applying to an organization or set of related entities organized for the purpose of providing service benefits to an enrolled population, for a predetermined fixed periodic amount to be paid by the purchaser (e.g., government, employer, individual).

LTC - Long Term Care

Managed Care- A broad term describing health and long term care coverage in which providers agree to negotiate payment levels for defined populations. Providers also typically agree to more aggressive utilization and quality assurance review than in traditional fee-for-service arrangements.

Managed Care Organization (MCO)- A broadly used term to describe any entity that utilizes managed care techniques for health care delivery. Can involve anything from a loose association of providers on a discounted fee-for-service arrangement to a highly-integrated provider organization utilizing a global capitated budget.

Medicaid/Medical Assistance/MA- A welfare program, adopted in 1965, to provide health insurance to eligible disabled and low-income people, administered by the federal government and participating states. The program's costs are shared by the federal government and state governments and paid for by general tax revenue.

Medicare- A federal entitlement program that covers the costs of hospitalization, medical care and some related services for eligible persons over age 65. Medicare has two parts: Part A covers inpatient costs including limited skilled nursing care, while Part B covers outpatient costs. Medicare pays for pharmaceuticals provided in hospitals, but not for those provided in an outpatient setting.

Minimum Data Set (MDS) - The MDS for nursing facility residents is a comprehensive resident assessment instrument that measures functional status, mental health status, and behavioral status. Under federal regulation, assessments are conducted at the time of admission into a nursing facility, upon return from a 72-hour hospital admission, whenever there is a significant change in status, quarterly, and annually.

Quality Assurance- A formal, systematic process to improve quality of care that includes monitoring quality, identifying inadequacies in delivery of care, and correcting those inadequacies.

Spousal Impoverishment Law - Refers to S.49.455, Wisconsin Statutes, which is designed to prevent the impoverishment of the noninstitutionalized spouse of an institutionalized MA recipient by reserving part of the couple's income and resources for the support of the spouse who is not institutionalized.

Subacute Care - A level of care for patients not requiring the intensity of services of a hospital, but that require some ancillary, nursing and support services beyond typical skilled nursing care.

WAHSA- Wisconsin Association of Homes and Services for the Aging -- WAHSA is a not-for-profit trade association representing not for-profit and governmental homes, housing projects and services for the aging. Currently this association represents 187 member corporations that own a total of 194 nursing homes, 22 ICF/MR facilities, 56 community based residential facilities, 91 independent living facilities, and more than 300 community service programs.

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WAHSA 204 South Hamilton Street Madison, WI 53703
Telephone: (608)255-7060 FAX:(608)255-7064