Glossary of Terms

CHC-MCO:

Community HealthChoices managed care organization; These are the health insurance plans that will be responsible for the physical health care and LTSS of their enrolled participants.

 

CNA:

Comprehensive Needs Assessment, assesses a Participant’s physical health, behavioral health, social, psychosocial, environmental, caregiver, LTSS, and other needs as well as preferences, goals, housing, and informal supports.

 

AAA:

Area Agency on Aging; These agencies provide and/or coordinate services to help older adults.

 

Applicants:

Individuals who are applying for or re-applying for Medicaid, long-term services and supports and any other benefits DHS offers.

 

CHC-MCO:

Community HealthChoices managed care organization; These are the health insurance plans that will be responsible for the physical health care and LTSS of their enrolled participants.

 

DHS:

The state Department of Human Services (formerly known as the Department of Public Welfare).

 

Dual Eligible:

An individual who receives both Medicare and Medicaid. In CHC, that includes individuals with Medicare Part A and/or Part B and Part D.

 

FED:

Functional Eligibility Determination; the questions asked to determine if an individual is clinically eligible for a nursing facility.

 

HCBS:

Home- and community-based services (also called waiver services). Supports and services beyond those covered by Medicaid to enable an individual to remain in a community setting rather than be admitted to a long-term care facility, such as a nursing home.

 

IEB:

Independent Enrollment Broker; An agency hired by the state to help people with the eligibility and enrollment process for CHC, HCBS and nursing homes.

LIFE Program:

Living Independence for the Elderly; An option, different than HCBS, that allows people ages 55 and older to live independently while receiving services and supports that meet the health and personal needs of the individual. LIFE is a managed-care program that provides a comprehensive, all-inclusive package of medical and supportive services.

 

LTSS:

Long-term services and supports; Services and supports to assist individuals to perform routine daily activities, such as bathing, dressing, preparing meals and taking medications.

 

Medicare:

A federal health insurance program for seniors ages 65 and older, and adults with disabilities who also receive Social Security Disability Insurance benefits.

 

NFCE:

Nursing Facility Clinically Eligible; An individual meets the criteria to receive services through a nursing facility.

 

NFI:

Nursing Facility Ineligible; An individual does not meet the criteria to receive services through a nursing facility.

 

OLTL:

Office of Long-Term Living; The office within the Department of Human Services that administers programs for adults with physical disabilities and older Pennsylvanians and is responsible for oversight of the CHC program.

 

Participants:

Those found eligible for the services/benefits for which they have applied.

 

SC:

Service Coordinator; A qualified professional who is the CHC–MCO’s designated point of contact for each participant’s person-centered service plan and coordination of services.

 

Waiver:

The way in which the federal government, waiving federal rules, allows states to provide Medicaid-funded services to people residing in the community who would otherwise be in an institution or nursing home to receive long-term care.

 

InterRAI:

The interRAI Home Care Assessment System (HC) is a person-centered assessment system that informs and guides comprehensive care and service planning in community-based settings around the world.