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Glossary beginning with C

Click one of the letters above to go to the page of all terms beginning with that letter.

C

Capitation

A program which reimburses providers and plans based on the number of persons under care, generally on a per member, per month (PMPM) basis. Payments are made at the same level, whether or not the member receives services during the month. Contrast capitation to fee-for-service, where payments are based on the actual units of service provided.

Care Management

Assessment and coordination of the overall care needs of a person, including both medical and social needs. A service in which a professional, typically a nurse or social worker, assists in planning, arranging, monitoring, or coordinating long term care services. Services may include making an assessment, creating a care plan, and arranging for services in multiple locations from numerous people and organizations. A Care Manager or Care Coordinator is a person who provides Care Management. This person can be a doctor, nurse, social worker or other similarly trained and, licensed professional.

Care Plan

A comprehensive plan for the care of a resident, developed by a multi-disciplinary team including family members, nurses, dieticians, physicians, therapists, and activities or social services professionals. The plan spells out the type of care to be provided, with stipulated timeframes for completion and assignment of responsibilities to specific staff. Nursing homes are mandated to create and maintain care plans for their residents, and surveyors review the plans for adequacy and follow-through. In some states, Assisted Living Facilities are also mandated to create and maintain care plans.

Caregiver

Individuals, often family members or friends, who provide assistance to see that the physical, psychological, and/or social needs of another person are met. Those who do so without pay are often called Informal Caregivers, to distinguish them from people who are paid to provide this assistance. The Primary Caregiver is the person who provides most of the care, and Secondary Caregivers are others who provide assistance on a part-time basis.

Case-Mix

Provider reimbursement calculated based on an assessment of the medical needs of the residents under care. A method by which a health care provider measures the service needs of the patient population, which may be based on age, medical diagnosis, severity of illness, or length of stay. Reimbursement is set at a standard amount for each type of care required, rather than the billed charges or the actual cost of providing that care.

Catastrophic Illness

Illness resulting in a massive and sudden change in a person's health and/or lifestyle, often accompanied by enormous medical bills.

Categorically Needy

An optional category of the Medicaid program which covers the cost of medical care for persons who would qualify for SSI but are not receiving it, perhaps because they are living in a nursing facility. Not all states have "categorically needy" programs.

Census

A count of the number of residents in the facility at midnight. Both Medicare and Medicaid programs require providers to document a midnight census. Since residents may be in more than one facility during a given day, the facility entitled to payment for the day is determined by identifying where the resident is staying at midnight.

Certificate

A Certificate is issued by a governmental or non-governmental organization to indicate that a person, facility, or program meets certain standards. Many certificates issued to individuals require a program of education which results in the certificate. For example, a Certified Nurse Aide must successfully complete certain classes to qualify for that certificate.
<p>In Medicare and Medicaid, certification refers to approval for providers to Participate in those programs. Licensed facilities might elect not to be Medicare- or Medicaid-certified if they planned to provide services only to private-paying residents. In some states, facilities can certify specific beds for Medicare or Medicaid, without certifying all beds in the facility for those programs, which is called partial certification. When a facility designates certain beds to be certified, those beds constitute a Distinct Part of the facility. Services to Medicare or Medicaid beneficiaries can only be provided in beds which are certified for the appropriate program.

Certificate of Need

Issued by the state organization responsible for healthcare facility licensure, a CON program limits the number of healthcare facilities which can be located in a market area, by requiring new providers to demonstrate and document that there is a need for their services. In some states there is a partial or total moratorium on CONs for nursing homes, where the State has determined that there are already too many facilities available for the population of that state.

Chronic Care

Continuing care provided over long periods of time without any expectation that the patientÂ’s level of functioning will necessarily improve, as opposed to the focus of Acute Care on curing disease and rehabilitation of the patient to a previous functional status. Chronic conditions often begin inconspicuously and symptoms are less pronounced than acute conditions. Chronic care services are provided by both

Chronic Condition

A general term that includes both chronic illnesses and impairments, including arthritis, cancer, heart disease, depression, hearing impairments, and vision problems. A disease or condition that lasts over a long period of time and typically cannot be cured. Chronic conditions often result in some type of disability.

Chronically Ill

Terminology used in Tax-Qualified Long Term Care Insurance policies. To qualify for coverage in a Tax-Qualified policy, the policyholder be certified as chronically ill by a licensed health care practitioner because they are not able to perform at least two Activities of Daily Living without substantial assistance for a period of at least 90 days, or because they require Substantial Supervision to protect themselves from threats to health and safety due to <i>Severe</i> Cognitive Impairment. Policies that are Tax-Qualified may pay benefits from the beginning of services, providing the services are expected to be needed for at least 90 days.

Co-Housing

Intergenerational communities where all members own their own private homes, but some meals and other community services are provided in shared facilities.

Cognitive Impairment

A loss or deterioration of mental capacity. A deficiency in a person's short or long term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment. Typically related to an illness or injury, like Alzheimers Disease, stroke, or traumatic brain injury.

Coinsurance

The specified portion of a medical bill that Medicare, Medicaid, or other insurance requires a patient. Coinsurance may be stated as a fixed amount or a percentage of a bill or procedure. This is part of the patient's Out-of-Pocket expense.

Comorbidity

The presence of two or more conditions or diseases in the same person.

Companionship Services

People who provide companionship to elderly and shut-in people, providing conversation, reading, and possibly light errands.

Congregate Housing

Dormitory-like settings where people live in the same building, occupy private rooms or apartments, and share some meals. Care is usually mostly custodial, with emergency medical assistance readily available. Some congregate housing may be rent-subsidized Section 8 housing.

Continence

One of the Activities of Daily Living (ADLs). The ability to control bowel and bladder function, use ostomy or catheter receptacles as needed, and apply diapers and disposable barrier pads as needed.

Continuing Care Retirement Community

A campus-style community with housing which ranges from independent cottages or apartments, to assisted living facilities, to nursing home beds, allowing residents to stay within the campus as their care needs change. CCRCs often require large entrance fees, which may or may not be refundable to the residents if they leave. Generally, CCRCs only admit residents who are able to live independently, and provide residents with access to appropriate on-campus services as their care needs change. The CCRC may promise to cover care costs for life via a Life Care Contract, or may guarantee access to other services or offer priority consideration if services are needed. The terms of these agreements may or may not provide some amount of free or discounted care.

Continuum of care

A description of the wide variety of long term care needs and services, from those for people who retain a significant ability to live independently with minimal assistance, to services for people who are severely ill, bedfast, or even comatose.

Cost Report

Reports provided to Medicare Intermediaries and state Medicaid Agencies by nursing homes and other healthcare providers. They are prepared on mandated forms, and there are extensive rules specifying which costs are allowable, and where and how these costs are to be reported. Costs reported may be used as the basis for “cost-based reimbursement.”

Cost-based reimbursement

Provider reimbursement rates which are set based on facility-specific costs as reported on the facility’s Cost Reports. Medicare skilled nursing facility rates were cost-based prior to 1999, but Medicare cost-based reimbursement has been replaced by the Skilled Nursing Facility Prospective Payment System. Many states use some form of cost-based reimbursement system to set Medicaid long term care reimbursement rates, although a number of states base Medicaid reimbursement on “case-mix” instead.

Curb-to-Curb

A common designation for Paratransit services. The transit vehicle picks up and discharges passengers at the curb or driveway in front of their home or destination. In curb-to-curb service the driver does not assist the passenger along walks or steps to the door of the home or other destination.

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