Glossary of Terms and Acronyms

AAFP (American Academy of Family Physicians)

American Academy of Family Physicians represents more than 115900 family physicians, family medicine residents, and medical students.

AAP (American Academy of Pediatrics)

An organization of 62,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.

ACA (Affordable Care Act)

Also known as Obamacare. A federal statute enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government.

ACC (Accountable Care Collaborative)

A Colorado Medicaid Health Plan with a focus on linking clients to Medical Homes and providing enhanced care coordination and cost savings.

ASQ (Ages and Stages Questionnaire)

A tool used by providers to screen children for developmental delays.

BHO (Behavioral Health Organizations)

Organizations contracted with the Colorado Department of Health Care Policy and Financing (HCPF) to serve as a managed care organization for behavioral health services for Medicaid recipients. They contract with community mental health centers and private mental health providers to provide services to clients.

Care Coordination/Care Management

A structured (deliberate) process that organizes patient/family care activities among the family, care team members and community resources to ensure the appropriate delivery of health care and other services meet the patient’s/family’s needs.

Cavity Free at Three (CF3)

A program to eliminate early childhood caries in Colorado’s children, helping them to grow up free of dental disease.

CBMS (Colorado Benefits Management System)

The computer system that determines eligibility about Medicaid and CHP+ and other programs.

CCHAP (Colorado Children’s Healthcare Access Program)

A non-profit organization devoted to advancing health equity and improving outcomes by promoting comprehensive, cost-effective, coordinated, quality health care for all children in Colorado.

CDPHE (Colorado Department of Public Health and Environment)

Regulates environmental health and safety and compiles vital statistics (birth, death, and health) for the state of Colorado.

Child Find

Professionals at school districts or other educational services, trained to evaluate children in areas including cognitive and physical functioning, hearing and vision, speech and language and social and emotional development.

CHIPRA (Children’s Health Insurance Program Reauthorization Act)

Enacted to strengthen the quality of care provided and health outcomes of children in Medicaid and CHIP.

CHP+ (Child Health Plan Plus)

Low-cost health insurance for Colorado’s uninsured children and pregnant women. CHP+ is public health insurance for children and pregnant women who earn too much to qualify for Medicaid, but cannot afford private health insurance.

CPT (Current Procedural Terminology)

5-digit numeric code used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services.

CRAFFT

A behavioral health screening tool consisting of a series of six questions for use with adolescents to screen for high risk alcohol and other drug use disorders.

Cross-Cultural Communications

Practical strategies and communications skills for more successful interactions between providers and patients from all cultural backgrounds.

EI (Early Intervention)

A federally and state funded program for children birth through two years who have been identified with a developmental delay or have been diagnosed with a condition that has a high probability of resulting in a delay.

EPSDT (Early and Periodic Screening, Diagnostic, and Treatment)

Medicaid’s comprehensive and preventive child health program for children under the age of 21.

FPG (Federal Poverty Guidelines)

Used to determine eligibility for many federally supported programs.

FQHC (Federally Qualified Health Center)

Health clinics that qualify for enhanced reimbursement from Medicare and Medicaid, and serve an underserved area or population.

HCPF (Colorado Department of Health Care Policy and Financing)

The department in the Colorado State Government that oversees all of the Medicaid and CHP+ programs.

Health Literacy

The ability of patients to understand basic health care information.

Healthy Communities

Outreach and case management services that focus on activities necessary for clients to obtain coverage and access to coordinated health care services in Medical Homes.

HEDIS (Healthcare Effectiveness Data and Information Set)

Tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service.

HIPAA (The Health Insurance Portability and Accountability Act)

Protects health insurance coverage for workers and their families when they change or lose their jobs, and requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

ICD-9/ICD-10 (International Classification of Diseases, 9th/10th Revision)

Used to code signs, symptoms, injuries, diseases, and conditions.

KPI (Key Performance Indicator)

An incentive program that is part of the Medicaid ACC that rewards providers for achieving certain quality performance goals.

LEP (Limited English Proficiency)

Having limited ability to understand or speak English.

Medical Home

A team based health care delivery model led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes.

Medicaid

Government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.

NCCI (National Correct Coding Initiative)

Published by both Medicaid and Medicare to support correct coding and claims adjudication.

NCQA (National Committee for Quality Assurance)

A private not-for-profit organization dedicated to improving health care quality.

NEMT (Non Emergent Medical Transportation)

Services provided to Medicaid eligible individuals who require transportation to a Medicaid funded medical appointment.

PCMP (Primary Care Medical Provider)

Providers contracted in the ACC.

PDSA (Plan, Do, Study, Act)

A quality improvement methodology.

Periodicity Schedule

A schedule of recommended preventive care services per age categories.

PMPM (Per Member Per Month)

A payment structure that pays a provider, practice or organization a set dollar amount for each member of client enrolled.

PRDS (Pregnancy Related Depression Screening or Postpartum Depression Screening)

Post-partum depression screening with a standardized, validated questionnaire is effective in identifying mothers with post-partum depression.

RCCO (Regional Care Collaborative Organization)

Currently seven organizations responsible for managing the care for Medicaid ACC clients state-wide.

RHC (Rural Health Clinics)

Federally qualified health clinics certified to receive special Medicare and Medicaid reimbursement to increase rural Medicare and Medicaid patients’ access to primary care services.

SCHIP (State Children’s Health Insurance Program)

See CHP+.

SBIRT (Screening, Brief Intervention and Referral to Treatment)

A screening program to help providers identify high risk for alcohol and drug abuse among their patients.

SCP (Service Care Plan)

The plan that must be completed for full benefit Medicare/Medicaid dual eligible patients.

SSI (Supplemental Security Income)

Designed to help aged, blind, and disabled people, who have little or no income.

TANF (Temporary Assistance for Needy Families)

Commonly known as welfare, provides monthly cash assistance program for needy families with children under age 18.