Here are more Medicaid terms you should be familiar with when doing business.
Mandatory Managed Care
Many states enroll beneficiaries on a mandatory basis into capitated managed care programs.
Allows states to extend Medicaid eligibility to additional qualified persons.
Medicare Modernization Act (MMA)
The Medicare Prescription Drug Improvement and Modernization Act provides seniors and individuals with disabilities with a prescription drug benefit and other Medicare benefits benefits.
Primary Care Case Management (PCCM)
A system under which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries.
Primary Care Case Manager
A physician, physician group practice, or an entity that employs or arranges with physicians to furnish primary care case management services.
The use of state taxes on health care providers to raise the state share (and thus increase federal matching payments) for making Medicaid payments.
The State Children’s Health Insurance Program(SCHIP)
Enacted in 1997 to provide a capped amount of federal matching funds to states for coverage of children and some parents with incomes too high to qualify for Medicaid.
Supplemental Security Income (SSI)
A federal income supplement program funded by general tax revenues.
Transfer of Assets
One is only eligible for Medicaid when their assets are reduced to minimum levels which vary from state to state and also with marital status. One must personally pay the bills for home care, nursing facility and other costs until their assets are reduced to Medicaid levels.
Upper Payment Limit (UPL)
UPLs have to do with the amounts state Medicaid programs can pay to providers for covered services. The UPL rule states that aggregate Medicaid payments to specific groups of providers cannot exceed a reasonable estimate of what would have been paid under Medicare payment principles.