Below is a list of agencies within the Centers for Medicare & Medicaid Services (CMS) and their functions, followed by a table listing health care reform acronyms with a description of each:
Federal Coordinated Health Care Office “Medicare-Medicaid Coordination Office” (CHCO)
Melanie Bella, Director. An office established by the health reform law to improve the integration of Medicare and Medicaid for “dual-eligible” individuals and foster all-inclusive care programs. With the aim of coordinating care more efficiently for dual-eligible beneficiaries.
Center for Medicare and Medicaid Innovation (CMI)
Richard Gilfillian, MD, Acting Director. This office was given the authority and direction through ACA to “test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care” for those who get Medicare, Medicaid or CHIP benefits. A new website has been launched, and you can find more information at http://innovations.cms.gov/
Center for Program Integrity (CPI)
Peter Budetti, M.D., Deputy Administrator and Director. CPI serves as a CMS’ focal point for all national and State-wide Medicare and Medicaid programs and CHIP integrity fraud and abuse issues.
Center for Consumer Information and Insurance Oversight (CCIIO)
Gary Cohen, Deputy Administrator and Director. CCIIO provides national leadership in setting and enforcing standards for health insurance through having the lead responsibility for drafting and enforcing regulations under the Affordable Care Act regarding the establishment of Health Insurance Exchanges and the offering of health plans through an Exchange.
HEALTH CARE REFORM ACRONYM |
DESCRIPTION |
| ACA or PPACA | Patient Protection and Affordable Care Act of 2010, Public Law 111-148 |
| ACO | Authorized as a new payment model under Medicare in the ACA, Accountable Care Organizations are to be a network of health care providers that band together to provide the full continuum of health care services for patients. |
| ARRA | American Recovery and Reinvestment Act of 2009, Pub.L. 111-5 (aka, Stimulus Bill) |
| AHBE | American Health Benefit Exchange (State administered insurance purchasing organization starting in 2014) |
| CHIP | Children’s Health Insurance Program, enacted in 1977. A federal-state program that provides health insurance coverage for uninsured low-income children who are not eligible for Medicaid. |
| CHIPRA | Children’s Health Insurance Program Reauthorization Act of 2009. |
| CO-OP | A Consumer Operated and Oriented Plan is a non-profit, member run health insurance organization authorized and funded under the ACA CO-OP program to foster competition in local insurance markets. |
| ECP | Essential Community Provider is a defined health care provider type under the ACA that serves low-income, medically-underserved individuals. |
| EHBP | Essential Health Benefits Package consists of the essential benefits, limits on cost-sharing, and has a specified actuarial value (i.e. pays for a specified percentage of costs). The essential health benefits are to be defined by the Secretary of Health and Human Services and must be defined to include the following categories of services: Ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. |
| FEHBP | Federal Employees Health Benefits Program provides health insurance to employees of the U.S. Federal government and, under the ACA, to employees of Tribes, tribal organizations and urban Indian organizations. |
| FMAP | Federal Medical Assistance Percentage. The ratio that determines the federal share of Medicaid health services costs. |
| FPL | Federal Poverty Level. Federal government’s working definition of poverty used as a standard for determining eligibility for public programs. |
| FR | Federal Register is the official daily publication for rules, proposed rules, and notices of Federal agencies and organizations, as well as executive orders and other presidential documents. |
| FSA | A Flexible Spending Account (or arrangement) is an account established through an employer cafeteria plan for pre-(payroll and income) tax spending on health care services. |
| FQHC | Federally Qualified Health Center is a designation that enables access to special reimbursement and grant opportunities under several Federal health programs, such as Medicare, Medicaid and HRSA. |
| GF | Grandfathered health plan – Under the ACA, individuals are allowed to maintain their coverage as it existed on the date of enactment (March 23, 2010), except even GF health plans are subject to new requirements on lifetime limits, coverage of adult children, and other items listed in ACA section 1251. |
| HCBS | Home and Community Based Services is service type under Medicaid which enables individuals to remain in their own home or live in a community setting, with the service previously available through a waiver but, with the ACA, can now be established through a State plan amendment. |
| HHS | U.S. Department of Health and Human Services. |
| HIPAA | Health Insurance Portability and Accountability Act of 1996, Pub.L. 104-91. This law set national standards for the protection of individually identifiable health information by three types of covered entities: health plans, health care clearinghouses, and health care providers. |
| HSA | Health Savings Accounts are tax preferred accounts tied to a high deductible health insurance plan, with out-of-pocket amounts subject to Federal limits. |
| HRP | High Risk Pools are state programs designed to provide health insurance to residents who are considered medically uninsurable and are unable to buy coverage in the individual market. |
| HRSA | The Federal Health Resources and Services Administration. |
| IFR | Interim Final Rule is a regulation from federal government. |
| PACE | Program of All-Inclusive Care for the Elderly, is a program under Medicare and Medicaid that provides comprehensive medical and social services for frail adults. |