Commonly Used Abbreviations and Acronyms

Abbreviation or Acronym	Definition
AAA	Area Agency on Aging
AAC	actual acquisition cost
ABA	applied behavioral analysis
ABP	alternative benefit plan
ACA	Patient Protection and Affordable Care Act
ACC	accountable care collaborative
ACF	Administration for Children and Families
ACIP	Advisory Committee on Immunization Practices
ACO	accountable care organization
ACS	American Community Survey
ADA	Americans with Disabilities Act
ADD	attention deficit disorder
ADHD	attention deficit hyperactivity disorder
ADL	activity of daily living
AFDC	Aid to Families with Dependent Children
AHRQ	Agency for Health Care Research and Quality
AIDS	acquired immune deficiency syndrome
AMP	average manufacturer price
APC	ambulatory payment classification
APRN	advanced practice registered nurse
APS	annual person summary
ARP	American Rescue Plan
ARTS	addiction and recovery treatment services
ASAM	American Society of Addiction Medicine
ASC	ambulatory surgical center
ASP	average sales price
ASPE	Assistant Secretary for Planning and Evaluation
AVS	asset verification system
AWP	average wholesale price
BBA 97	Balanced Budget Act of 1997
BHH	behavioral health homes
BHO	behavioral health organization
BHP	Basic Health Program
BIP	Balancing Incentive Payments Program
BMI	body mass index
BOE	basis of eligibility
BRFSS	Behavioral Risk Factor Surveillance System
CAH	critical access hospital
CAHMI	Child and Adolescent Health Measurement Initiative
CAHPS	Consumer Assessment of Health Care Providers and Systems
CARF	Commission on Accreditation of Rehabilitation Facilities
CARTS	CHIP Annual Reporting Template System
CBO	Congressional Budget Office
CBT	cognitive-behavioral therapy
CCBHC	certified community behavioral health clinic
CCIIO	Center for Consumer Information and Insurance Oversight
CCN	CMS certification number
CCO	coordinated care organization
CCPD	continuous cycling peritoneal dialysis
CCR	cost-to-charge ratio
CCW	Chronic Condition Data Warehouse
CDC	U.S. Centers for Disease Control and Prevention
CDL	clinical diagnostic laboratory
CDPS	Chronic Illness and Disability Payment System
CDT	Current Dental Terminology
CEHRT	certified electronic health record technology
CF	conversion factor
CHAMP-VA	Civilian Health and Medical Program of the Department of Veterans Affairs
CHIP	State Children’s Health Insurance Program
CHIPRA	Children’s Health Insurance Program Re-Authorization Act
CHNA	community health needs assessment
CIN	client identification number
CLIA	Clinical Laboratory Improvement Amendments of 1988
CMC	comprehensive managed care
CMCS	Center for Medicaid and CHIP Services
CMHC	community mental health center
CMIP	comprehensive Medicaid integrity plan
CMS	Centers for Medicare & Medicaid Services
CNM	certified nurse-midwife
CNOM	costs not otherwise matchable
CNS	clinical nurse specialist
COBRA	Consolidated Omnibus Budget Reconciliation Act of 1985
CORD	Childhood Obesity Research Demonstration
CPE	certified public expenditure
CPI	Center for Program Integrity
CPI-U	consumer price index for all urban consumers
CPNP	certified pediatric nurse practitioner
CPS	Current Population Survey
CPT	Current Procedural Terminology. CPT® is a registered trademark of the American Medical Association
CRNA	certified registered nurse anesthetists
CRNP	certified registered nurse practitioner
CSHCN	children with special health care needs
CSR	cost-sharing reduction
CT	computerized tomography
CTA	computerized tomography angiography
CY	calendar year
DHRM	DSH Health Reform Methodology
DME	durable medical equipment
DOJ	U.S. Department of Justice
DRA	Deficit Reduction Act
DRG	diagnosis-related group
DSH	disproportionate share hospital
DSM	Diagnostic and Statistical Manual of Mental Disorders
D-SNP	dual-eligible special needs plan
DSRIP	delivery system reform incentive payment
DSRIP PPS	delivery system reform incentive payment performing provider system
DUR	drug utilization review
DxCG	diagnostic cost group risk adjustment model
E/M	evaluation and management
EAC	estimated acquisition cost
EAPG	enhanced ambulatory patient group
ECP	essential community provider
ED	emergency department
E-FMAP	enhanced federal medical assistance percentage
EHB	essential health benefit
EHR	electronic health record
EKG	electrocardiogram
ELE	express lane eligibility
EMTALA	Emergency Medical Treatment and Active Labor Act
EPSDT	early and periodic screening, diagnostic, and treatment
EQR	external quality review
EQRO	external quality review organization
ESI	employer-sponsored insurance
ESRD	end-stage renal disease
FAI	Financial Alignment Initiative
FCA	False Claims Act
FCHCO	Federal Coordinated Health Care Office
FDA	U.S. Food and Drug Administration
FERA	Fraud Enforcement and Recovery Act
FFCRA	Families First Coronavirus Response Act
FFP	federal financial participation
FFS	fee for service
FIDE SNP	fully integrated dual-eligible special needs plan
FMAP	federal medical assistance percentage
FMR	financial management report
FOA	Family Opportunity Act
FPG	federal poverty guidelines
FPL	federal poverty level
FQHC	federally qualified health center
FUL	federal upper limit
FY	fiscal year (October 1–September 30)
FYE	full-year equivalent
GAO	U.S. Government Accountability Office
GDP	gross domestic product
GME	graduate medical education
GPP	global payment program
HCAC	health care-acquired condition
HCBS	home- and community-based services
HCC	hierarchical condition category
HCERA	Health Care and Education Reconciliation Act
HCFA	Health Care Financing Administration
HCFAC	Health Care Fraud and Abuse Control Program
HCPCS	Health Care Common Procedure Coding System
HCRIS	Health Care Cost Report Information System
HCRP	high-cost risk pool
HCUP	Health Care Cost and Utilization Project
HEAT	Health Care Fraud Prevention and Enforcement Action Team
HEDIS	Health Care Effectiveness Data and Information Set
HHS	U.S. Department of Health and Human Services
HIDE SNP	highly integrated dual-eligible special needs plan
HIE	health information exchange
HIO	health insuring organization
HIPAA	Health Insurance Portability and Accountability Act
HIT	health information technology
HIU	health insurance unit
HMO	health maintenance organization
HMOA	Health Maintenance Organization Act
HOPD	hospital outpatient department
HPSA	health professional shortage area
HRA	health risk assessment
HRMS	Health Reform Monitoring Survey
HRR	hospital referral region
HRSA	Health Resources and Services Administration
HSI	health services initiative
IBNRS	Incurred But Not Reported Survey
ICD-10	International Classification of Diseases, 10th Edition
ICF	intermediate care facility
ICF/IID	intermediate care facilities for individuals with intellectual disabilities
ICT	integrated care team
I/DD	intellectual or developmental disabilities
IADL	instrumental activity of daily living
IDR	integrated data repository
IGT	intergovernmental transfer
IHS	Indian Health Service
IMD	institutions for mental diseases
IME	indirect medical education
IMU	Index of Medical Underservice
IOM	Institute of Medicine
IOP	intensive outpatient program
IPPS	inpatient prospective payment system
IPUMS	Integrated Public Use Microdata Series
IRC	Internal Revenue Code
IRS	Internal Revenue Service
LADC	licensed alcohol and drug counselor
LEA	local education agency
LIHP	low-income health program
LIS	low-income subsidy
LM	licensed midwife
LOC	level of care
LPR	legal permanent resident
LTSS	long-term services and supports
MA	Medicare Advantage
MACBIS	Medicaid and CHIP Business Information Solutions
MACPAC	Medicaid and CHIP Payment and Access Commission
MACRA	Medicare and CHIP Reauthorization Act
MAGI	modified adjusted gross income
MAP	Measure Applications Partnership
MAS	maintenance assistance status
MAT	medication assisted treatment
MAX	Medicaid Analytic eXtract
MBES/CBES	Medicaid Budget and Expenditure System/State Children’s Health Budget and Expenditure System
MBI	Medicaid buy-in
MCCA	Medicare Catastrophic Coverage Act
MCE	managed care entity
MCH	maternal and child health
MCHB	Maternal and Child Health Bureau
MCO	managed care organization
MDE	major depressive episode
MDRP	Medicaid Drug Rebate Program
MEC	minimum essential coverage
Medi-Medi Program	Medicare-Medicaid Data Match Program
MedPAC	Medicare Payment Advisory Commission
MEMA	member enrollment mix adjustment
MEPS	Medical Expenditure Panel Survey
MEPS-HC	Medical Expenditure Panel Survey–Household Component
MEPS-IC	Medical Expenditure Panel Survey–Insurance Component
MEQS	Medicaid Eligibility Quality Control System
MFCU	Medicaid Fraud Control Unit
MFP	Money Follows the Person
MFSDB	Medicare fee schedule database
MH/SUD	mental health/substance use disorder
MHPA	Mental Health Parity Act of 1996
MHPAEA	Mental Health Parity and Addiction Equity Act of 2008
MIC	Medicaid integrity contractor
MIG	Medicaid integrity group
MII	Medicaid Integrity Institute
MIP	Medicaid Integrity Program
MIPPA	Medicare Improvements for Patients and Providers Act
MITA	Medicaid Information Technology Architecture
MLR	medical loss ratio
MLTSS	managed long-term services and supports
MMA	Medicare Modernization Act
MMCDCS	Medicaid Managed Care Data Collection System
MMCO	Medicare-Medicaid Coordination Office
MMIS	Medicaid Management Information Systems
MMLR	minimum medical loss ratio
MMNA	monthly maintenance of need allowance
MMP	Medicare-Medicaid Plan
MMSEA	Medicare, Medicaid, and SCHIP Extension Act of 2007
MOE	maintenance of effort
MOMS	Maternal Opiate Medicine Support Project
MOU	memorandum of understanding
MOUD	medications to treat opioid use disorder
MRA	magnetic resonance angiogram
MRI	magnetic resonance imaging
MRS	magnetic resonance spectroscopy
MSA	metropolitan statistical area
MSIS	Medicaid Statistical Information System
MSP	Medicare Savings Program
MSTAT	Medicaid State Technical Assistance Teams
MUA	medically underserved area
MUP	medically underserved population
NADAC	National Average Drug Acquisition Cost Survey
NAMCS	National Ambulatory Medical Care Survey
NAMD	National Association of Medicaid Directors
NCANDS	National Child Abuse and Neglect Data System
NCCI	National Correct Coding Initiative
NCHS	National Center for Health Statistics
NDC	National Drug Code
NEDS	Nationwide Emergency Department Sample
NEHRS	National Electronic Health Records Survey
NEMT	non-emergency medical transportation
NF	nursing facility
NFLOC	nursing facility level of care
NHAMCS	National Hospital Ambulatory Care Survey
NHE	national health expenditures
NHIS	National Health Interview Survey
NHRA	Nursing Home Reform Act
NHSC	National Health Service Corps
NICU	neonatal intensive care unit
NIDA	National Institute on Drug Abuse
NIPT	non-institutional provider team
NIRT	National Institutional Reimbursement Team
NIS	nationwide inpatient sample
N-MHSS	National Mental Health Services Survey
NPI	national provider identifier
NPPES	National Plan and Provider Enumeration System
NPR	net patient revenue
NSCAW	National Survey of Child and Adolescent Well-Being
NSCH	National Survey of Children’s Health
NSCSHCN	National Survey of Children with Special Health Care Needs
NSDUH	National Survey on Drug Use and Health
NSLP	National School Lunch Program
N-SSATS	National Survey of Substance Abuse Treatment Services
OACT	Office of the Actuary
OASI	Old-Age and Survivors Insurance Trust Fund
OB-GYN	obstetrician-gynecologist
OBRA	Omnibus Budget Reconciliation Act
ODWCC	outpatient departmental weight cost-to-charge
OE	operating expenses
OFM	Office of Financial Management
OIG	Office of Inspector General
OMB	Office of Management and Budget
OPD	outpatient department
OPFS	outpatient prospective fee schedule
OPM	U.S. Office of Personnel Management
OPPC	other provider preventable conditions
OPPS	outpatient prospective payment system
OT	occupational therapy
OTC	over the counter
OTP	opioid treatment program
OUD	opioid use disorder
P4P	pay for performance
PA	physician assistant
PACE	Program of All-inclusive Care for the Elderly
PAHP	prepaid ambulatory health plans
PAPE	payment amount per episode
PBM	pharmacy benefit manager
PBRHC	provider-based rural health clinic
PCA	personal care attendant
PCC	primary care clinician
PCCM	primary care case management
PCMH	patient-centered medical home
PCP	primary care provider
PCPCH	patient-centered primary care home
PCPCP	primary care partial capitation provider
PCRI	primary care rate increase
PDL	preferred drug list
PDMP	prescription drug monitoring program
PERM	Payment Error Rate Measurement Program
PET	positron emission tomography
PHE	public health emergency
PHP	prepaid health plan
PHUP	Partial Hospitalization Units Program
PI	program integrity
PIHP	prepaid inpatient health plan
PMH	pregnancy medical home
PMP	primary medical provider
PMPM	per member per month
PMPY	per member per year
PNA	personal needs allowance
POS	point of service
PPC	provider preventable conditions
PPO	preferred provider organization
PPS	prospective payment system
PQMP	Pediatric Quality Measures Program
PRAMS	Pregnancy Risk Assessment Monitoring System
ProPAC	Prospective Payment Assessment Commission
PRR	patient review and restriction programs
PRTF	psychiatric residential treatment facility
PT	physical therapy
QDWI	qualifying disabled and working individual
QHP	qualified health plan
QI	qualifying individual
QMB	qualified Medicare beneficiary
QPP	Quality Payment Program
QRTP	qualified residential treatment program
RAC	recovery audit contract
RBRVS	resource-based relative value scale
RBRVU	resource-based relative value units
RCCO	regional care collaborative organizations
RDU	renal dialysis units
RFI	request for information
RFP	request for proposal
RHC	rural health clinic
RNFA	registered nurse first assistants
RVU	relative value unit
SAMHSA	Substance Abuse and Mental Health Services Administration
SBHC	school-based health center
SBIRT	screening, brief intervention and referral to treatment
SDMI	severe disabling mental illness
SED	severe (or serious) emotional disturbance
SEDD	state emergency department database
SEDS	Statistical Enrollment Data System
SFY	state fiscal year (July 1–June 30)
SGA	substantial gainful activity
SHADAC	State Health Access Data Assistance Center
SHIP	State Health Insurance Assistance Programs
SIL	special income level
SIM	State Innovation Models Program
SIPP	Survey of Income and Program Participation
SLMB	specified low-income Medicare beneficiary
SLP	speech and language pathology
SMAC	state maximum allowable cost
SMD	state Medicaid director
SMI	serious mental illness
SMMM	severe maternal mortality and morbidity
SNAP	Supplemental Nutrition Assistance Program
SNF	skilled nursing facility
SNP	special needs plan
SOTA	State Operations and Technical Assistance Initiative
SPA	state plan amendment
SPMI	serious persistent mental illness
SPRY	state plan rate year
SSA	Social Security Administration
SSBG	Social Services Block Grant
SSDI	Social Security Disability Insurance
SSI	Supplemental Security Income
ST	speech therapy
SUD	substance use disorder
SUPPORT Act	Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act
TANF	Temporary Assistance for Needy Families
TAP	technical advisory panel
TBI/SCI	traumatic brain or spinal cord injury
TEFRA	Tax Equity and Fiscal Responsibility Act
TEFT	Testing Experiences and Functional Tools Demonstration
TMA	transitional medical assistance
T-MSIS	Transformed Medicaid Statistical Information System
TNC	transportation network companies
TPL	third party liability
TTWIIA	Ticket to Work and Work Incentives Improvement Act
U&C	usual and customary
UC	uncompensated care
UCC	uncompensated care cost
UCR	usual and customary rate
UDS	uniform data system
UPL	upper payment limit
URA	unit rebate amount
USC	usual source of care
USPSTF	U.S. Preventive Services Task Force
VA	U.S. Department of Veterans Affairs
VBP	value-based purchasing
VFC	Vaccines for Children program
WAC	wholesale acquisition cost
WCC	weighted cost-to-charge
WDI	working disabled individual
WIC	Special Supplemental Nutrition Program for Women, Infants, and Children
ZPIC	Zone Program Integrity Contractor