2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Appendix B. DefinitionsTerm Definition Sourcehealth homeMeans, as defined in Section 2703 of PPACA, an individual provider, team of health careprofessionals, or health team that meets all federal requirements and provides the followingsix services to persons with one or more specified chronic conditions: (i) comprehensive caremanagement; (ii) care coordination and health promotion; (iii) comprehensive transitionalcare/follow-up; (iv) patient and family support; (v) referral to community and social supportservices; and (vi) use of health information technology (HIT) to link services, if applicable.HSDhealth informationtechnology (HIT)health literacyHealthcare EffectivenessData and Information Set(HEDIS) ®high-volume specialty careprovidersMeans the area of information technology involving the design, development, creation, useand maintenance of information systems for the health care industry.Means the degree to which members are able to obtain, process, and understand basichealth information and services needed to make appropriate health decisions.Means the tool used by health plans to measure performance of certain health care criteriadeveloped by the National Community for Quality Assurance (NCQA).Means providers of anesthesia, cardiology, gastroenterology, general surgery, obstetrics andgynecology, oncology, ophthalmology, orthopedics, and radiation oncology. High-volumespecialists are identified as in-plan providers not identified as primary care providers who arepaid the highest amount per year based on claims submitted, encounter data, and theinclusion of health care costs across all product lines.HIPAA Means the Health Insurance Portability and Accountability Act of 1996, 42 USC 160, et seq. HSDHITECH Act Means the Health Information Technology for Economic and Clinical Health Act of 2009; 42USC 17931, et seq.health risk assessment Assessment performed per HSD guidelines and processes for the purpose of (i) introducing(HRA)the MCO to the member, (ii) obtaining basic health and demographic information about themember, (iii) assisting the MCO in determining the level of care coordination needed by themember, and (iv) determining the need for a nursing facility level of care (NF LOC)assessment.Indian Health Service (IHS)Indian Health Service/tribalhealth providers/urbanIndian providers (I/T/U)instrumental activities ofdaily living (IADL)Interagency BehavioralHealth PurchasingCollaborative (aka TheCollaborative)Means the division of the United States Department of Health and Human Servicesresponsible for providing health services to Native Americans.A collective term that references any or all of the three types of providers.Means doing housework; taking medications as prescribed; managing money; shopping forgroceries or clothing; use of telephone or other form of communication; using technology (asapplicable); and using transportation within the community.http://en.wikipedia.org/wiki/Activities_of_daily_livingCollaborative created by Governor Bill Richardson and the New Mexico State Legislatureduring the 2004 Legislative Session (State Statute). The legislation allows several stateagencies and resources involved in behavioral health prevention, treatment, and recovery towork as one in an effort to improve mental health and substance abuse services in NewMexico. This cabinet-level group represents 15 state agencies and the governor’s office.HSDHSDHSDHSDHSDHSDsee linksee linkThe Collaborative consists of the secretaries of aging and long-term services; Indian affairs;human services; health; corrections; children, youth and families; finance and administration;workforce solutions; public education; and transportation. It also consists of the directors ofthe administrative office of the courts; the New Mexico mortgage finance authority; thegovernor's commission on disability; the developmental disabilities planning council; theinstructional support and vocational rehabilitation division of the public education department;and the New Mexico health policy commission; and the governor's health policy coordinator,or their designees. The Collaborative is chaired by the Secretary of Human Services with therespective secretaries of Health (Services) and Children, Youth and Families (CYFD)alternating annually as co-chairs. http://www.bhc.state.nm.us/B-52014 Practitioner and Provider Manual - Ver. 3