Glossary

A contractor hired under this SOW.

PACE combines medical, social, and long-term care services for frail people. PACE is available only in states that have chosen to offer it under Medicaid. To be eligible, you must:

• Be 55 years old, or older,
• Live in the service area of the PACE program,
• Be certified as eligible for nursing home care by the appropriate state agency , and
• Be able to live safely in the community.

The goal of PACE is to help people stay independent and live in their community as long as possible, while getting high quality care they need.

An appointed person who is responsible overall for a project. A
departmental person is usually appointed.

Degree of variation between estimated and actual amounts.

The good and bad parts of treatment for a health problem. For example, a medicine may help your pain (pro), but it may cause an upset stomach (con).

A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, DRGs for inpatient hospital services).

Individually identifiable health information transmitted or maintained in any form or medium, which is held by a covered entity or its business associate.
Identifies the individual or offers a reasonable basis for identification.
Is created or received by a covered entity or an employer
Relates to a past, present, or future physical or mental condition, provision of health care or payment for health care.

Any Medicare provider (e.g., hospital, skilled nursing facility, home health agency, outpatient physical therapy, comprehensive outpatient rehabilitation facility, end-stage renal disease facility, hospice, physician, non-physician provider, laboratory, supplier, etc.) providing medical services covered under Medicare Part B.
Any organization, institution, or individual that provides health care services to Medicare beneficiaries. Physicians, ambulatory surgical centers, and outpatient clinics are some of the providers of services covered under Medicare Part B.

A doctor, hospital, health care professional, or health care facility.

The providers with which an M+C Organization contracts or makes arrangements to furnishcovered health care services to Medicare enrollees under an M+C coordinated care or networkMSA plan.