AHRQ (Agency for Healthcare Research and Quality) The lead Public Health Service agency charged with supporting research designed to improve the quality of health care, to increase the efficiency of its delivery, and to broaden access to the most essential health services.
ATSDR (Agency for Toxic Substances and Disease Registry) Tasked with investigating and reducing the harmful effects of exposure to hazardous substances on human health. Most of the administrative functions for ATSDR are provided by CDC and the Director of CDC serves as Administrator of ATSDR.
biologics A preparation, such as a drug or a vaccine, that is made from living organisms (see also, follow-on biologic).
CDC (Centers for Disease Control and Prevention) The nation’s principal public health agency, providing coordination and support for a variety of population-based disease and injury control activities.
CDHC (Consumer Driven Health Care) A broad spectrum of approaches that give incentives to consumers to control their use of health services and/or ration their own health benefits.
CMS (Center for Medicare and Medicaid Services) Organization within HHS tasked with handling both Medicare and Medicaid. CMS is responsible for implementing and enforcing regulations.
community rating Insurance reform proposal that would require insurers to charge the same price to every policyholder, regardless of age, sex, or any other indicator of health risk; modified community rating allows for difference based on age and sex.
DME (Durable Medical Equipment) Certain types of equipment, like oxygen supplies, hospital beds, and wheelchairs, that will be paid for by Medicare for those who require them.
DSH (Disproportionate Share Hospital) A program designed to offset uncompensated costs incurred by no-pay patients and un-reimbursed Medicaid claims assumed by hospitals.
EMTALA (Emergency Medical Treatment and Active Labor Act) Ensures universal access to emergency medical care at all Medicare participating hospitals with emergency departments. Under EMTALA, any person who seeks emergency medical care at a covered facility, regardless of ability to pay, immigration status, or any other characteristic, is guaranteed an appropriate screening exam and stabilization treatment before transfer or discharge. Failure to abide by these requirements can subject hospitals or physicians to civil monetary sanctions or exclusion from Medicare. Hospitals may also be subject to civil liability under the statute for personal injuries resulting from the violation. Congressional Research Service
ERISA (Employee Retirement Income Security Act 1974) Established minimum standards for pension plans in private industry and provides for extensive rules on the federal income tax effects of transactions associated with employee benefit plans.
FDA (Food and Drug Administration) Regulates more than $1 trillion worth of products, which account for 25 cents of every dollar spent annually by American consumers. It regulates the safety of foods (including animal feeds) and the safety and effectiveness of drugs, biologics, and medical devices.
follow-on biologic Similar but not identical to the brand-name, or innovator, product made by the pharmaceutical or biotechnology industry.
GME (Graduate Medical Education) Clinical training in an approved residency program following graduation from schools of medicine, osteopathy, dentistry, and podiatry; Medicare, and in some states Medicaid, make payments to teaching hospitals for GME costs.
group market Health insurance provided to groups of people drawn together by an employer or another organization, like a trade union.
guaranteed issue Insurance reform proposal that would require insurers to issue a policy to an individual regardless of health status.
HSA (Health Savings Account) Tax-advantaged medical savings account available to individuals enrolled in High Deductible Health Plans (HDHP, see below); funds contributed to the account are not subject to tax at the time of deposit and funds used to pay for certain medical expenses are exempt from federal tax liability; important component of Consumer Driven Health Care.
HDHP (High Deductible Health Plan) A health insurance plan with lower premiums and higher deductibles than a traditional plan; also known as a catastrophic health insurance plan; requirement for Health Savings Accounts; minimum deductible is $1,100 for individuals and $2,200 for families.
HHS (Department of Health and Human Services) Cabinet-level department with the goal of protecting the health of all Americans and providing essential human services; oversees Public Health Service Agencies.
HIPAA (Health Insurance Portability and Accountability Act 1996) Guarantees the availability and renewability of health insurance coverage for certain employees and individuals, and limits the use of patient information.
HIT (Health Information Technology) Allows comprehensive management of medical information and its secure exchange between health care consumers and providers; broad use of HIT will improve quality, prevent medical errors, reduce costs, increase efficiency, decrease paperwork, and expand access.
HRSA (Health Resources and Services Administration) Provides leadership and support for health services and resources for people who are uninsured, isolated, or medically vulnerable; also known as the Access Agency.
IHS (Indian Health Service) Provides, or funds the provision of, direct health care services to members of the nation’s 562 federally recognized Indian tribes (totaling about 1.8 million Indians in 35 states).
individual market Consumers not associated with a group purchase their own insurance in this market; consumers in the individual market usually face rigorous health screening; also know as the non-group market.
IPA (Independent Practice Association) An association of independent physicians, or other organization that contracts with independent physicians, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis. IPAs are generally risk-bearing entities and regulated by the FTC.
Medicaid Federal-state partnership to provide health coverage for primarily poor adults.
Medicare Federal program to provide health insurance for individuals age 65+.
MEDPAC (Medicare Payment Advisory Commission) An independent Congressional agency established by the Balanced Budget Act to advise the Congress on issues affecting the Medicare program.
MEI (Medicare Economic Index) Measures the weighted average annual price changes in the inputs needed to produce services; updated by CMS annually; more accurate than SGR (see below).
NHSC (National Health Service Corps) Committed to improving the health of the nation’s underserved by uniting communities in need with caring health professional and supporting communities’ efforts to build better systems of care. Part of HRSA.
NIH (National Institutes of Health) Primary agency of the federal government charged with conducting and supporting biomedical and behavioral research. It also has major roles in research training and health information dissemination.
PBM (Pharmaceutical Benefits Manager) Negotiates drug discounts with manufacturers and act as the intermediary purchaser of prescription drugs for businesses as part of the health benefits they may offer.
Physician Owned Hospital Hospitals partially owned and run by physicians; concerns exist about conflict of interest and self-referral.
SAMHSA (Substance Abuse and Mental Health Services Administration) Supports states’ efforts to enhance prevention and treatment programs for substance abuse and mental health disorders through block, formula, and discretionary grants.
SCHIP (State Children’s Health Insurance Program) Federal-state partnership intended to provide health coverage for poor children.
SGR (Sustainable Growth Rate) A volume-based payment mechanism that adjusts Medicare physician payments on an annual basis. Because the volume and intensity of physician services often exceed the targets established by SGR, negative payment updates are scheduled for Medicare physicians on an annual basis.
SNF (Skilled Nursing Facility) Nursing homes; commonly called “sniffs”; Medicare pays for a beneficiary’s SNF services if he or she has been discharged from a hospital after a three day stay and/or per a doctor’s orders.
supplemental coverage Usually a product sold to cover benefits not included in a primary health plan. Prior to the implementation of Medicare Part D, for example, supplemental policies would provide seniors with drug coverage.
