Commonly Used Abbreviations and Acronyms

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 and CHIP Budget 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
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