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Definitions and abbreviations

Definitions

Activities of daily living (ADL): Personal care tasks such as bathing, dressing, toileting, transferring, and eating or feeding. A person’s degree of dependence in doing these activities helps decide the right level of care and service needs.

Appeal: Contesting (disagreeing with) an action from DMAS or a contractor. Examples of appealable issues include denials of eligibility, whole or partial denials of approval for medical services, payment denials, and audit findings.

Asset transfer: Medicaid applicants and members must be paid back in full for any transfers of money, property or other assets.

Authorized Representative: Person given written permission to manage someone’s personal or financial affairs.

Caseworker/Worker: Eligibility worker at the local department of social services (DSS) who processes the Medicaid application and manages the case. This is the person to contact about changes to address or income, or about problems such as not receiving a Medicaid card.

Certified Application Assistor: Volunteer trained by the government that you authorize to help you apply.

Co-insurance: The part of Medicare, Medicaid or other insurance charges that the patient pays.

Co-payment or co-pay: The part of Medicaid charges that a member must pay directly to the provider for certain services or procedures.

Cover Virginia Call Center: Call 1-855-242-8282 to get program information, to apply by phone for Medicaid and FAMIS, and to get translation services and referrals to CommonHelp or your local social services agency for other benefit programs.

Department of Medical Assistance Services (DMAS): The agency that runs the Virginia Medicaid program.

Department of social services (DSS): The agency that determines eligibility for medical assistance and social services. This includes local departments of social services.

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT): Preventive health care and well-child checkups, tests, and immunizations (shots) for children and youth from birth to age 21. EPSDT may cover medically necessary services needed to correct or improve defects and physical or mental illnesses found in a screening, even if they are not covered by Medicaid.

Eligibility worker: Worker at the local department of social services who reviews your application for Medicaid, FAMIS or Plan First to find out if you qualify. This is the person to contact about changes to address or income, or problems such as not receiving your Medicaid card.

Family Access to Medical Insurance Security (FAMIS): Health coverage for uninsured children from birth through age 18. The Virginia Department of Medical Assistance Services (DMAS) runs FAMIS. The state and federal government funds FAMIS.

FAMIS Select: Lets families of FAMIS-eligible children choose between coverage in FAMIS or through a private or employer-sponsored health plan. Children in FAMIS Select get health coverage through their private or employer-sponsored health plan. They show their plan ID card for payment. They do not have direct FAMIS coverage, except if needed to cover childhood immunizations (shots).

Fraud: Deliberately withholding or hiding information or lying to get or try to get Medicaid.

Generic drugs: The Food and Drug Administration (FDA) requires generic drugs to have the same quality, strength, purity and stability as brand-name drugs. Generic drugs are less expensive than brand-name drugs.

Health Insurance Marketplace (HIM): Online marketplace of private insurance plans. You can shop for health insurance, compare private plans and find out if you qualify for  help paying for coverage.

Individualized Family Service Plan (IFSP): A plan for early intervention supports and services. A team writes the IFSP, with the child's family as the most important members. A good IFSP suits each child and family’s routines, activities, strengths and needs. It reflects the family’s priorities for the child’s development. In the IFSP, the family gets information about the child’s development, outcomes and goals, supports and services, and the transition plan to support the child and family as they leave the early intervention system.

Managed care: Most Virginia Medicaid members get medical care through managed care programs in which they are assigned to a health plan. They work with their primary care provider (PCP) to coordinate their medical care, ensure access to the right providers and promote preventive care to achieve positive health outcomes.

Managed care organization (MCO): A health plan contracted with Medicaid to provide medical services and coordinate health care services through a network (group) of providers.

Medicaid: Program that provides access to health care for one in five Virginians.

Medicaid for children: The Medicaid program for children.

Medically necessary: Services needed for the diagnosis or treatment of an illness or injury.

Patient pay: Share of the cost of long-term supports and services that persons with income may have to pay.

Primary care provider (PCP): The doctor or clinic that provides most personal health care needs, gives referrals to other health care providers when needed, and monitors Medicaid member health. The PCP may be an internist, a pediatrician (children’s doctor), OB/GYN (women’s doctor), or certain clinics and health departments.

Resources (assets): Includes money on hand and in a bank or safe deposit box, stocks, bonds, certificates of deposit, trusts, pre-paid burial plans, cars, boats, life insurance policies and real property.

Smiles for Children: Virginia’s dental program for children enrolled in Medicaid, FAMIS and Medicaid for children. Dental services will be available to adults in Medicaid starting July 2021.

Social Security Administration: The federal agency that runs the Social Security program for retirement, disability and survivors' benefits.

State plan: A Medicaid and CHIP state plan is an agreement between a state and the federal government that describes how that state runs its Medicaid and CHIP programs. It assures that a state will obey federal rules. It may claim federal matching funds for its program activities. The state plan shows who is covered, services provided, ways providers will be paid and administrative activities in the state.

Supplemental Security Income (SSI): A federal program that the Social Security Administration runs. SSI pays monthly benefits to persons who are disabled, blind or age 65 or older with limited income and resources. Children and adults who are blind or disabled can get SSI benefits.

Uniform Assessment Instrument (UAI): Pre-admission screening form to evaluate an applicants’ ability to complete activities of daily living.

Waiver (or Medicaid Waiver): A Medicaid Waiver lets a state drop certain Medicaid program rules. This lets the state provide care for people who might not otherwise qualify for Medicaid. The Waiver must be approved by the federal government.

Abbreviations

An abbreviation formed from the first letters of other words.

Abbreviations

Abbreviation

Definition

ABD Medicaid

Aged, Blind, or Disabled Medicaid

ACA

Patient Protection and Affordable Care Act (also called PPACA or Obamacare)

ADLs

Activities of daily living

ARTS

Addiction and Recovery Treatment Services

ALF

Assisted Living Facility

AR

Authorized Representative

AT

Asset Transfer or Assistive Technology

CCF

Common Core Formulary

CD

Consumer-Directed

CW

Caseworker

CAA

Certified Application Assister

CMS

Centers for Medicare and Medicaid Services

CCC

Commonwealth Coordinated Care

CCC Plus

Commonwealth Coordinated Care Plus

CCC Plus Waiver

Commonwealth Coordinated Care Plus Waiver (merged the Elderly or Disabled with Consumer Direction Waiver and Technology Assisted Waiver)

DBHDS

Department of Behavioral Health and Developmental Services

DMAS

Department of Medical Assistance Services

DME

Durable Medical Equipment

DD Waivers

Developmental Disability Waiver Services: (1) Building Independence (BI); (2) Community Living (CL); and (3) Family & Individual Supports (FIS)

DSS

Department of social services (sometimes called VDSS for Virginia Department of Social Services)

EM

Environmental Modification

EPSDT

Early and Periodic Screening, Diagnosis, and Treatment

EVV

Electronic Visit Verification

FAD

Final Agency Decision

FAMIS

Family Access to Medical Insurance Security

FQHC

Federally Qualified Health Center

GA

General Assembly

HHR

Health and Human Resources

HIM 

Health Insurance Marketplace

ID

Intellectual Disability

IFSP

Individualized Family Service Plan

LTSS

Long-Term Supports & Services

MAC

Member Advisory Committee

Marketplace Health Insurance Marketplace

MC

Managed care

MCO

Managed care organization

MN

Medically necessary

M4

Medallion 4.0 program

NF

Nursing facility

OAG

Office of the Attorney General

OCMO

Office of the Chief Medical Officer

OTC

Over-the-counter medication

PDL

Preferred Drug List

POA

Power of Attorney

PP

Patient pay

PCP

Primary care provider

SNF

Skilled nursing facility

SSA

Social Security Administration

SSI

Supplemental Security Income

UAI

Uniform Assessment Instrument

VDH

Virginia Department of Health