Glossary beginning with D

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The amount that a patient is expected to pay before Medicare, Medicaid, or Insurance will start paying. Generally, deductibles are set as a fixed amount per year, but Medicare Part A deductibles are calculated as a fixed amount per Benefit Period.


The type of Paratransit service where individual passengers can request transportation from a specific location to another specific location at a certain time. Transit vehicles providing demand-response service do not follow a fixed route, but travel throughout the community transporting passengers according to their specific requests. These services usually, but not always, require advance reservations.


The loss of cognitive or intellectual function. This term describes a group of symptoms that encompass a loss of intellectual ability, mental processes, vocabulary, abstract thinking, judgment, memory loss, and physical coordination that interfere with daily activities. The symptoms can be brought on by degenerative diseases like Alzheimers, Huntington's and Parkinson's diseases, vascular diseases, stroke, metabolic disorders like thyroid, liver kidney dysfunction, certain vitamin deficiencies, AIDS, drugs and alcohol, or psychiatric disorders. Some dementing disorders may respond to treatments, others do not.


A disorder in which the body cannot convert foods properly into the energy needed for daily activities. There are two main types of diabetes. Type I, or insulin-dependent, is the more severe for of the disease. Type II, or adult onset, is the more common form and accounts for more than 85% of all cases. Diabetes cannot be cured, but it can be controlled by regulating the diet, getting regular exercise, and in some cases taking medication or insulin.

Disability Model

A type of Long Term Care Insurance which pays benefits directly to the insured when the individual becomes disabled, whether or not long-term care expenses are incurred. The insured has the freedom to spend the disability payment on whatever services he/she deems appropriate.


The exit of a resident or patient from a facility or program. A discharge may be to another facility or program, to the residentÂ’s home, or could be a death. Payors vary in how they reimburse for days of discharge. Generally, Medicare and Medicaid do not pay facilities or programs per diem costs for the day of discharge, although they may pay for some services provided on the discharge day.

Distinct Part

A portion of a nursing facility Certified for either Medicare or Medicaid, if the facility has not certified 100% of their beds for those programs. The distinct part is treated as though it was a separate facility for purposes of allocating income and expenses on cost reports, and for making and reporting admissions, discharges, and other census information.


A form of Paratransit service which includes passenger assistance between the vehicle and the door of his or her home or other destination. A higher level of service than curb-to-curb, yet not as specialized as Adoor-through-door@ service (where the driver actually provides assistance within the origin or destination).


One of the Activities of Daily Living (ADLs). The ability to put on and take off all garments and medically necessary braces, corsets, elastic stockings or garments or artificial limbs or splints usually worn and to fasten and unfasten them.


Person who is eligible for both Medicare and Medicaid. Most Medicaid beneficiaries age 65 or over are dual-eligibles. Benefits and programs for dual-eligibles are often different than for other Medicaid beneficiaries because of their access to Medicare benefits and services. For example, many states with Medicaid managed care programs specifically omit dual-eligibles from those programs. Dual-eligibles who need a nursing home level of care may be covered under newly-emerging Programs of All-Inclusive Care for the Elderly.

Durable Medical Equipment

Equipment that lasts for several years, like wheelchairs, scooters, hospital beds, oxygen tanks, and other equipment, as contrasted with consumable medical supplies, such as diapers and dressings, which are not considered DME. DME is often coverable under Medicare or Medicaid or both.

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