| Abbreviation or Acronym | Definition |
| AAC | actual acquisition cost |
| AAP | American Academy of Pediatrics |
| AAPD | American Academy of Pediatric Dentistry |
| ABA | applied behavioral analysis |
| ABP | alternative benefit plan |
| ACA | Patient Protection and Affordable Care Act |
| ACAP | Association for Community Affiliated Plans |
| ACC | accountable care collaborative |
| ACF | Administration for Children and Families |
| ACIP | Advisory Committee on Immunization Practices |
| ACO | accountable care organization |
| ACS | American Community Survey |
| ADA | Americans with Disabilities Act |
| ADD | attention deficit disorder |
| ADHD | attention deficit hyperactivity disorder |
| ADLs | activities of daily living |
| ADT | admission, discharge, transfer |
| AFCARS | Adoption and Foster Care Analysis Reporting System |
| AFDC | Aid to Families with Dependent Children |
| AHA | American Hospital Association |
| AHCA | American Health Care Association |
| AHCCCS | Arizona Health Care Cost Containment System Administration (Arizona’s Medicaid Agency) |
| AHRQ | Agency for Health Care Research and Quality |
| AIDS | acquired immune deficiency syndrome |
| AMA | American Medical Association |
| AMP | average manufacturer price |
| APC | ambulatory payment classification |
| APRN | advanced practice registered nurse |
| APS | annual person summary |
| ARC | Acuarial Research Corporation |
| ARTS | addiction and recovery treatment services |
| ASAM | American Society of Addiction Medicine |
| ASC | ambulatory surgical center |
| ASP | average sales price |
| ASPE | Assistant Secretary for Planning and Evaluation |
| AWP | average wholesale price |
| BBA 97 | Balanced Budget Act of 1997 |
| BHH | behavioral health homes |
| BHO | behavioral health organization |
| BHP | basic health program |
| BIP | Balancing Incentive Payments Program |
| BMI | body mass index |
| BOE | basis of eligibility |
| BRFSS | Behavioral Risk Factor Surveillance System |
| CAH | critical access hospital |
| CAHMI | Child and Adolescent Health Measurement Initiative |
| CAHPS | Consumer Assessment of Health Care Providers and Systems |
| CAPD | continuous ambulatory peritoneal dialysis |
| CARF | Commission on Accreditation of Rehabilitation Facilities |
| CARTS | CHIP Annual Reporting Template System |
| CBO | Congressional Budget Office |
| CBT | cognitive-behavioral therapy |
| CCC | Community Care Collaborative |
| CCCESUN | children with chronic conditions and elevated service use or need |
| CCIIO | Center for Consumer Information and Insurance Oversight |
| CCN | CMS certification number |
| CCO | coordinated care organization |
| CCPD | continuous cycling peritoneal dialysis |
| CCR | cost-to-charge ratio |
| CCW | Chronic Condition Data Warehouse |
| CDC | U.S. Centers for Disease Control and Prevention |
| CDL | clinical diagnostic laboratory |
| CDPS | Chronic Illness and Disability Payment System |
| CDT | Current Dental Terminology |
| CF | conversion factor |
| CHAMP-VA | Civilian Health and Medical Program of the Department of Veterans Affairs |
| CHIP | State Children’s Health Insurance Program |
| CHIPRA | Children’s Health Insurance Program Re-Authorization Act |
| CHNA | community health needs assessment |
| CIN | client identification number |
| CLIA | Clinical Laboratory Improvement Amendments of 1988 |
| CMC | comprehensive managed care |
| CMCS | Center for Medicaid and CHIP Services |
| CMHC | community mental health center |
| CMIP | comprehensive Medicaid integrity plan |
| CMS | Centers for Medicare & Medicaid Services |
| CNM | certified nurse-midwife |
| CNOM | costs not otherwise matchable |
| CNS | clinical nurse specialist |
| COA | Council on Accreditation of Services for Families and Children |
| COBRA | Consolidated Omnibus Budget Reconciliation Act of 1985 |
| CORD | The Childhood Obesity Research Demonstration |
| CPE | certified public expenditure |
| CPI | Center for Program Integrity |
| CPI-U | consumer price index for all urban consumers |
| CPNP | certified pediatric nurse practitioners |
| CPS | Current Population Survey |
| CPT | Current Procedural Terminology. CPT® is a registered trademark of the American Medical Association |
| CRNA | certified registered nurse anesthetists |
| CRNP | certified registered nurse practitioner |
| CRNW | certified registered nurse-midwife |
| CSHCN | children with special health care needs |
| CSR | cost-sharing reduction |
| CT | computerized tomography |
| CTA | computerized tomography anigrogphy |
| CY | calendar year |
| DHCF | Department of Health Care Finance |
| DHCS | Department of Health Care Services |
| DHR | Department of Human Resources |
| DHRM | DSH Health Reform Methodology |
| DHSS | Department of Health and Social Services |
| DHW | Department of Health and Welfare |
| DMAP | Division of Medical Assistance Programs |
| DMAP | Delaware Medical Assistance Programs |
| DMAS | Department of Medical Assistance Services |
| DME | durable medical equipment |
| DOH | Department of Health |
| DOJ | U.S. Department of Justice |
| DRA | Deficit Reduction Act |
| DRG | diagnosis-related group |
| DSH | disproportionate share hospital |
| DSM | Diagnostic and Statistical Manual of Mental Disorders |
| D-SNP | dual-eligible special needs plan |
| DSRIP | delivery system reform incentive payment |
| DSRIP PPS | delivery system reform incentive payment performing provider system |
| DUR | drug utilization review |
| DVHA | Department of Vermont Health Access |
| DxCG | diagnostic cost group risk adjustment model |
| DYS | Department of Youth Services |
| E/M | evaluation and management |
| EAC | estimated acquisition cost |
| EAPG | enhanced ambulatory patient group |
| ECP | essential community provider |
| ED | emergency department |
| EDZ | economically disadvantaged zone |
| E-FMAP | enhanced federal medical assistance percentage |
| EHB | essential health benefit |
| EHR | electronic health record |
| EKG | electrocardiogram |
| ELE | express lane eligibility |
| EMTALA | Emergency Medical Treatment and Active Labor Act |
| EPSDT | early and periodic screening, diagnostic, and treatment |
| EQR | external quality review |
| EQRO | external quality review organization |
| ESI | employer-sponsored insurance |
| ESRD | end-stage renal disease |
| FACS | Family and Children’s Services |
| FCA | False Claims Act |
| FCHCO | Federal Coordinated Health Care Office |
| FDA | Food and Drug Administration |
| FERA | Fraud Enforcement and Recovery Act |
| FFP | federal financial participation |
| FFS | fee for service |
| FHIAP | Family Health Insurance Assistance Program |
| FIDE SNP | fully integrated dual-eligible special needs plan |
| FMAP | federal medical assistance percentage |
| FMR | financial management report |
| FOA | Family Opportunity Act |
| FPG | federal poverty guidelines |
| FPL | federal poverty level |
| FQHC | federally qualified health center |
| FSSA | Family and Social Services Administration |
| FUL | federal upper limit |
| FY | fiscal year (October 1–September 30) |
| FYE | full-year equivalent |
| GAO | U.S. Government Accountability Office |
| GDP | gross domestic product |
| GME | graduate medical education |
| GPP | global payment program |
| HAN | health access network |
| HBO | hyperbaric oxygen therapy |
| HCA | health care authority |
| HCAC | health care-acquired condition |
| HCBS | home- and community-based services |
| HCC | hierarchical condition category |
| HCERA | Health Care and Education Reconciliation Act |
| HCFA | Health Care Financing Administration |
| HCFAC | Health Care Fraud and Abuse Control Program |
| HCPCS | Health Care Common Procedure Coding System |
| HCPF | health care policy and financing |
| HCRIS | Health Care Cost Report Information System |
| HCRP | high-cost risk pool |
| HCUP | Health Care Cost and Utilization Project |
| HEAT | Health Care Fraud Prevention and Enforcement Action Team |
| HEDIS | Health Care Effectiveness Data and Information Set |
| HHS | U.S. Department of Health and Human Services |
| HHSC | Health and Human Services Commission |
| HIE | health information exchange |
| HIO | health insuring organization |
| HIP | Healthy Indiana Program |
| HIPAA | Health Insurance Portability and Accountability Act |
| HIT | health information technology |
| HIU | health insurance unit |
| HMO | health maintenance organization |
| HMOA | Health Maintenance Organization Act |
| HOPD | hospital outpatient department |
| HP20 | Healthy People 2020 |
| HPSA | health professional shortage area |
| HRA | health risk assessment |
| HRET | Health Research and Educational Trust |
| HRMS | Health Reform Monitoring Survey |
| HRSA | Health Resources and Services Administration |
| IBNRS | Incurred But Not Reported Survey |
| ICD | International Classification of Diseases |
| ICD-10 | International Classification of Diseases, 10th Edition |
| ICF | intermediate care facility |
| ICF/ID | intermediate care facility for people with intellectual disabilities |
| ICT | integrated care team |
| ID/DD | intellectual or developmental disabilities |
| IDALs | instrumental activities of daily living |
| IDR | integrated data repository |
| IGT | intergovernmental transfer |
| IHCP | Indiana Health Coverage Program |
| IHI | Institute for Health Care Improvement |
| IHS | Indian Health Service |
| IMD | Institutions for Mental Diseases |
| IME | indirect medical education |
| IMU | Index of Medical Underservice |
| IOM | Institute of Medicine |
| IOP | intensive outpatient program |
| IPPS | inpatient prospective payment system |
| IPUMS | Integrated Public Use Microdata Series |
| IRC | Internal Revenue Code |
| IRS | Internal Revenue Service |
| KCMU | Kaiser Commission on Medicaid and the Uninsured |
| KDHE | Kansas Department of Health and Environment |
| KFF | Kaiser Family Foundation |
| LADC | licensed alcohol and drug counselor |
| LEA | local education agency |
| LIHP | low-income health program |
| LINKS | Louisiana Immunization Network for Kids Statewide |
| LIS | low-income subsidy |
| LM | licensed midwife |
| LOC | level of care |
| LPR | legal permanent resident |
| LTSS | long-term services and supports |
| MA | Medicare Advantage |
| MACBIS | Medicaid and CHIP Business Information Solutions |
| MACPAC | Medicaid and CHIP Payment and Access Commission |
| MACRA | Medicare and CHIP Reauthorization Act |
| MAGI | modified adjusted gross income |
| MAP | Measure Applications Partnership |
| MAS | maintenance assistance status |
| MAT | medication assisted treatment |
| MAX | Medicaid Analytic eXtract |
| MBES/CBES | Medicaid Budget and Expenditure System/State Children’s Health Budget and Expenditure System |
| MBI | Medicaid buy-in |
| MCCA | Medicare Catastrophic Coverage Act |
| MCE | Medicaid coverage expansion (or managed care entity) |
| MCH | maternal and child health |
| MCHA | maternal and child health access |
| MCHB | Maternal and Child Health Bureau |
| MCO | managed care organization |
| MDCH | Michigan Department of Community Health |
| MDHHS | Michigan Department of Health and Human Services |
| MEC | minimum essential coverage |
| Medi-Medi Program | Medicare-Medicaid Data Match Program |
| MedPAC | Medicare Payment Advisory Commission |
| MEMA | member enrollmement mix adjustment |
| MEPS | Medical Expenditure Panel Survey |
| MEPS-HC | Medical Expenditure Panel Survey–Household Component |
| MEPS-IC | Medical Expenditure Panel Survey–Insurance Component |
| MEQS | Medicaid Eligibility Quality Control System |
| MFCU | Medicaid Fraud Control Unit |
| MFP | Money Follows the Person |
| MFSDB | Medicare fee schedule database |
| MH/SUD | mental health/substance use disorder |
| MHCP | Minnesota Health Care Program |
| MHPA | Mental Health Parity Act of 1996 |
| MHPAEA | Mental Health Parity and Addiction Equity Act of 2008 |
| MIC | Medicaid integrity contractor |
| MIG | Medicaid integrity group |
| MIHMS | Maine Integrated Health Management Solution |
| MII | Medicaid Integrity Institute |
| MIP | Medicaid Integrity Program |
| MIPPA | Medicare Improvements for Patients and Providers Act |
| MITA | Medicaid Information Technology Architecture |
| MLR | medical loss ratio |
| MLTSS | managed long-term services and supports |
| MMA | Medicare Modernization Act |
| MMCDCS | Medicaid Managed Care Data Collection System |
| MMCO | Medicare-Medicaid Coordination Office |
| MMIS | Medicaid Management Information Systems |
| MMLR | minimum medical loss ratio |
| MMNA | monthly maintenance of need allowance |
| MMSEA | Medicare, Medicaid, and SCHIP Extension Act of 2007 |
| MOE | maintenance of effort |
| MOMS | Maternal Opiate Medicine Support Project |
| MOU | memorandum of understanding |
| MOUD | medications to treat opioid use disorder |
| MRA | magnetic resonance angiogram |
| MRCP | magnetic resonance cholangiopancreatography |
| MRI | magnetic resonance imaging |
| MRS | magnetic resonance spectroscopy |
| MSA | metropolitan statistical area |
| MSHO | Minnesota Senior Health Options |
| MSIS | Medicaid Statistical Information System |
| MSP | Medicare Savings Program |
| MSTAT | Medicaid State Technical Assistance Teams |
| MUA | medically underserved area |
| MUP | medically underserved population |
| NADAC | National Average Drug Acquisition Cost Survey |
| NAMCS | National Ambulatory Medical Care Survey |
| NAMD | National Association of Medicaid Directors |
| NASBO | National Association of State Budget Officers |
| NASHP | National Academy of State Health Policy |
| NASUAD | National Association of States United for Aging and Disabilities |
| NCANDS | National Child Abuse and Neglect Data System |
| NCCI | National Correct Coding Initiative |
| NCHC | North Carolina Health Choice |
| NCHS | National Center for Health Statistics |
| NCQA | National Committee for Quality Assurance |
| NCSL | National Conference of State Legislatures |
| NDC | National Drug Code |
| NDDoH | North Dakota Department of Health |
| NEDS | Nationwide Emergency Department Sample |
| NEHRS | National Electronic Health Records Survey |
| NEMT | non-emergency medical transportation |
| NESCO | New England States Consortium Systems Organization |
| NF | nursing facility |
| NFIB | National Federation of Independent Business |
| NFLOC | nursing facility level of care |
| NGA | National Governors Association |
| NHAMCS | National Hospital Ambulatory Care Survey |
| NHCM | New Hampshire certified midwives |
| NHE | national health expenditures |
| NHIS | National Health Interview Survey |
| NHPF | National Health Policy Forum |
| NHRA | Nursing Home Reform Act |
| NHSC | National Health Service Corps |
| NICU | neonatal intensive care unit |
| NIDA | National Institute on Drug Abuse |
| NIPT | Non-Institutional Provider Team |
| NIRT | National Institutional Reimbursement Team |
| NIS | nationwide inpatient sample |
| NPI | national provider identifier |
| NPPES | National Plan and Provider Enumeration System |
| NPR | net patient revenue |
| NQF | National Quality Forum |
| NSCAW | National Survey of Child and Adolescent Well-Being |
| NSCH | National Survey of Children’s Health |
| NSCLC | National Senior Citizens Law Center |
| NSCSHCN | National Survey of Children with Special Health Care Needs |
| NSDUH | National Survey on Drug Use and Health |
| NSLP | National School Lunch Program |
| OACT | Office of the Actuary |
| OASI | Old-Age and Survivors Insurance Trust Fund |
| OB-GYN | obstetrician-gynecologist |
| OBRA | Omnibus Budget Reconciliation Act |
| ODWCC | outpatient departmental weight cost-to-charge |
| OE | operating expenses |
| OFM | Office of Financial Management |
| OHA | Oregon Health Authority |
| OHCA | Oklahoma Health Care Authority |
| OHP | Oregon Health Plan |
| OIG | Office of Inspector General |
| OMB | Office of Management and Budget |
| OPD | outpatient department |
| OPFS | outpatient prospective fee schedule |
| OPM | U.S. Office of Personnel Management |
| OPPC | other provider preventable conditions |
| OPPS | outpatient prospective payment system |
| OT | occupational therapy |
| OTC | over-the-counter |
| OTP | opioid treatment program |
| P4P | pay for performance |
| PA | physician assistant |
| PAAS | Physician Assured Access System |
| PACE | Program of All-inclusive Care for the Elderly |
| PAHP | prehapid ambulatory health plans |
| PAPE | payment amount per episode |
| PBFQHC | provider-based federally qualified health center |
| PBM | pharmacy benefit manager |
| PBRHC | provider-based rural health clinic |
| PCA | personal care attendant |
| PCC | primary care clinician |
| PCCM | primary care case management |
| PCMH | patient-centered medical home |
| PCP | primary care provider |
| PCPCH | patient-centered primary care home |
| PCPCP | primary care partial capitation provider |
| PCRI | primary care rate increase |
| PDL | preferred drug list |
| PDMP | prescription drug monitoring program |
| PERM | Payment Error Rate Measurement Program |
| PET | positron emission tomography |
| PHAB | Public Health Accreditation Board |
| PHP | prepaid health plan |
| PHUP | Partial Hospitalization Units Program |
| PI | program integrity |
| PIHP | prepaid inpatient health plan |
| PMH | pregnancy medical home |
| PMP | primary medical provider |
| PMPM | per member per month |
| PMPY | per member per year |
| PNA | personal needs allowance |
| POPS | Pharmacy On-Line Processing System |
| POS | point of service |
| PPAC | Preferred Physicians and Children Program |
| PPC | provider preventable conditions |
| PPO | preferred provider organization |
| PPS | prospective payment system |
| PQMP | Pediatric Quality Measures Program |
| ProPAC | Prospective Payment Access Commission |
| PRR | patient review and restriction programs |
| PT | physical therapy |
| QDWI | qualifying disabled and working individual |
| QHP | qualified health plan |
| QI | qualifying individual |
| QMB | qualified Medicare beneficiary |
| RAC | recovery audit contract |
| RBRVS | resource-based relative value scale |
| RBRVU | resource-based relative value units |
| RCCO | regional care collaborative organizations |
| RDU | renal dyalysis units |
| RFI | request for information |
| RFP | request for proposal |
| RHC | rural health clinic |
| RNFA | registered nurse first assistants |
| RPICC | regional perinatal intensive care centers |
| RVU | relative value unit |
| SAMHSA | Substance Abuse and Mental Health Services Administration |
| SBHC | school-based health center |
| SBIRT | screening, brief intervention and referral to treatment |
| SCDHHS | South Carolina Department of Health and Human Services |
| SCH | sole community hospital |
| SCO | senior care options |
| SDMI | severe disabling mental illness |
| SED | severe (or serious) emotional disturbance |
| SEDD | state emergency department database |
| SEDS | Statistical Enrollment Data System |
| SFY | state fiscal year (July 1–June 30) |
| SGA | substantial gainful activity |
| SHADAC | State Health Access Data Assistance Center |
| SHIP | State Health Insurance Assistance Programs |
| SHOPP | Supplemental Hospital Offset Payment Program |
| SI | status indicator |
| SIL | special income level |
| SIM | state innovation models |
| SIPP | Survey of Income and Program Participation |
| SLMB | specified low-income Medicare beneficiary |
| SLP | speech and language pathology |
| SMAC | state maximum allowable cost |
| SMD | state Medicaid director |
| SMI | serious mental illness |
| SNAP | Supplemental Nutrition Assistance Program |
| SNF | skilled nursing facility |
| SNP | special needs plan |
| SOTA | State Operations and Technical Assistance Initiative |
| SPA | state plan amendment |
| SPMI | serious persistent mental illness |
| SPRY | state plan rate year |
| SSA | Social Security Administration |
| SSBG | Social Services Block Grant |
| SSDI | Social Security Disability Insurance |
| SSI | Supplemental Security Income |
| ST | speech therapy |
| SUD | substance use disorder |
| TANF | Temporary Assistance for Needy Families |
| TAR | treatment authorization request |
| TBI/SCI | traumatic brain or spinal cord injury |
| TEACH | Training and Education for the Advancement of Children’s Health Program |
| TEFRA | Tax Equity and Fiscal Responsibility Act |
| TEFT | Testing Experiences and Functional Tools Demonstration |
| TMA | transitional medical assistance |
| TMPPM | Texas Medicaid Provider Procedures Manual |
| T-MSIS | Transformed Medicaid Statistical Information System |
| TPL | third pary liability |
| TTWIIA | Ticket to Work and Work Incentives Improvement Act |
| U&C | usual and customary |
| UC | uncompenstated care |
| UCC | uncompensated care cost |
| UCR | usual and customary rate |
| UDS | uniform data system |
| UPL | upper payment limit |
| URA | unit rebate amount |
| USC | usual source of care |
| USPSTF | U.S. Preventive Services Task Force |
| VA | U.S. Department of Veterans Affairs |
| VFC | Vaccines for Children program |
| WAC | wholesale acquisition cost |
| WCC | weighted cost-to-charge |
| WDI | working disabled individual |
| WIC | Special Supplemental Nutrition Program for Women, Infants, and Children |
| ZPIC | Zone Program Integrity Contractor |