Glossary

Funds included in the trust fund to serve as a cushion in case actual expenditures are higher than those projected at the time financing was established. Since the financing is set prospectively, actual experience may be different from the estimates used in setting the financing.

An amount included in the actuarial rates to provide for changes in the contingency level in the trust fund. Positive margins increase the contingency level, and negative margins decrease it.

Allows MCOs to offer enrollees the option of continued enrollment in the M+C plan when enrollees leave the plan’s service area to reside elsewhere. CMS has interpreted this to be on apermanent basis. M+C Organizations that choose the continuation of enrollment option must explain it in marketing materials and make it available to all enrollees in the service area. Enrollees may choose to exercise this option when they move or they may choose to disenroll.

A housing community that provides different levels of care based on what each resident needs over time. This is sometimes called "life care" and can range from independent living in an apartment to assisted living to full-time care in a nursing home. Residents move from one setting to another based on their needs but continue to live as part of the community. Care in CCRCs is usually expensive. Generally, CCRCs require a large payment before you move in and charge monthly fees.

A type of dialysis where the patient's peritoneal membrane is used as the dialyzer. The patient dialyzes at home, using special supplies, but without the need for a machine (see peritoneal dialysis).

A type of dialysis where the patient generally dialyzes at home and utilizes an automated peritoneal cycler for delivering dialysis exchanges (see peritoneal dialysis).

A process which continually monitors program performance. When a quality problem is identified, CQI develops a revised approach to that problem and monitors implementation and success of the revised approach. The process includes involvement at all stages by all organizations, which are affected by the problem and/or involved in implementing the revised approach.

An entity that has an agreement with CMS or another funding agency to perform a project.

Policy developed by CMS Contractors (PSC, AC, FI, or carrier) and used to make coverage and coding determinations. It is developed when:

• there is an absence of national coverage policy for a service or all of the uses of a service;
• there is a need to interpret national coverage policy; or
• local coding rules are needed.

See "Maximum tax base."