Glossary

Some States use the findings of private accreditation organizations, in part or in whole, to supplement or substitute for State oversight of some quality related standards. This is referred to as "deemed compliance" with a standard.

State requirement that plans must be accredited to participate in the Medicaid managed care program.

Means having a seal of approval. Being accredited means that a facility or health care organization has met certain quality standards. These standards are set by private, nationally recognized groups that check on the quality of care at health care facilities and organizations. Organizations that accredit Medicare Managed Care Plans include the National Committee for Quality Assurance, the Joint Commission on Accreditation of Healthcare Organizations, and the American Accreditation HealthCare Commission/URAC.

An organization that has been accredited by ANSI for the development of American National Standards.

Term for legislation that passed through Congress and was signed by the President or passed over his veto.

Activities you usually do during a normal day such as getting in and out of bed, dressing, bathing, eating, and using the bathroom.

The amount of money a doctor or supplier charges for a certain medical service or supply. This amount is often more than the amount Medicare approves. (See Approved Amount; Assignment.)

The difference between the summarized income rate and the summarized cost rate over a given valuation period.

A negative actuarial balance.

One half of the expected monthly cost of the SMI program for each aged enrollee (for the aged actuarial rate) and one half of the expected monthly cost for each disabled enrollee (for the disabled actuarial rate) for the duration the rate is in effect.