Aged, Blind, and Disabled (ABD): One category of the general population that Medicaid serves through Title XIX of the Social Security Act.
Case Management: Services which help beneficiaries gain access to needed medical, social, educational, and other services.
Centers for Medicare & Medicaid Services (CMS): The agency within the US Department of Health and Human Services responsible for the administration of several key federal health care programs, including Medicaid.
Code of Federal Regulations (CFR, C.F.R.): A publication of all the regulations issued by Federal administrative agencies.
Community Long Term Care (CLTC): A division within SCDHHS that operates home and community-based waiver programs for persons eligible for nursing home care but who prefer to receive their services in their homes. The division is now called "Long Term Living."
Compliance: Following established guidelines, specifications, or legislation.
Conflict-Free Case Management (CFCM): Case management services should be "conflict free." This requirement has the following characteristics:
- Separation of case management from direct services. This helps assure free choice for participants in choosing services and providers. It also serves to prevent any influence from a case manager on a participant to choose the case manager's organization if the organization also provides direct services.
- Separation of eligibility determination from direct services.
- Case managers do not establish the levels of funding for individuals.
- Anyone who is conducting evaluations, assessments and the plan of care/service plan cannot be related by blood or marriage to the individual or any of his or her paid caregivers.
Direct Care: The provisions of individual care by a staff member through a face-to-face encounter. It may involve aspects of health care, counseling, self-care, education, and assistance with activities of daily living.
Federal Financial Participation (FFP): The distribution of federal dollars to states to pay for a percentage of every Medicaid service.
Federal Medical Assistance Percentage (FMAP): The portion of the Medicaid program which is paid by the Federal government.
Healthy Connections: South Carolina’s Medicaid program, operated by SCDHHS, which includes the State Plan services and Waiver Programs.
Home and Community-Based Services (HCBS): Services provided in the home or community to persons who meet an institutional level of care in an effort to keep people home and out of institutions.
Home and Community-Based Settings Requirement: The actual location or place where an individual receives home and community-based (waiver) services. Home and community-based settings do not include:
- Nursing homes;
- Institutions for mental diseases (IMD);
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID);
- Hospitals; and
- Any other location that has qualities of an institution.
Level of Care (LOC): The amount of assistance an individual requires to meet their needs.
Long Term Living (LTL): Formerly CLTC, a division within SCDHHS that operates home and community-based waiver programs for persons eligible for nursing home care but who prefer to receive their services in their homes.
Medicaid: A medical assistance program that helps pay for some or all medical bills for the many people who cannot afford medical care. The program also assists individuals who are over 65 or have a disability with the costs of nursing facility care and other medical expenses. South Carolina Department of Health and Human Services operates the state's Medicaid Program, Healthy Connections.
Medicaid Targeted Case Management (MTCM): Case management services which are aimed specifically at special groups of Medicaid-enrollees such as those with developmental disabilities or chronic mental illness.
Person-Centered Planning: A process with the beneficiary at the center that leads to the development of a person-centered service plan that reflects the services and supports important for the individual to meet their identified needs.
Personal Health Information (PHI): Demographic information, medical history and diagnoses, test and lab results, insurance information, personal dietary plans, treatment information, and other data about an individual collected by a healthcare professional to determine and provide appropriate care.
Personally Identifiable Information (PII): Any data that could personally identify a specific individual.
Setting: The actual location or place where an individual receives home and community-based (waiver) services.
South Carolina Department of Disabilities and Special Needs (SCDDSN or DDSN): South Carolina’s state agency tasked with providing services for persons with intellectual disabilities, related disabilities, head injuries, spinal cord injuries, or autism spectrum disorder and their families.
South Carolina Department of Health and Human Services (SCDHHS or DHHS): The Single State Agency designated as the administrator of all Medicaid Programs, known as Healthy Connections, in South Carolina.
South Carolina Department of Mental Health (SCDMH): South Carolina's state agency that provides services and support for adults, children, and their families affected by serious mental illness and significant emotional disorders.
State Plan Services: Services available to all Medicaid-eligible persons, including individuals receiving services from a waiver program.
Waiver Program: A Medicaid program states can create to provide tailored long-term care services in home and community based settings rather than institutional settings. In South Carolina we have seven (7) waiver programs:
- Community Choices waiver program: Serves persons, 18 or older, who are unable to perform activities of daily living and who meet a nursing facility level of care criteria.
- Community Supports (CS) waiver program: Serves persons diagnosed with intellectual disabilities or related disabilities and who meet the intermediate care facilities for individuals with intellectual disabilities (ICF/IID) level of care criteria.
- Head and Spinal Cord Injury (HASCI) waiver program: Serves individuals diagnosed with severe physical impairments involving head and/or spinal cord injuries and who meet either nursing facility or intermediate care facilities for individuals with intellectual disabilities (ICF/IID) level of care criteria.
- HIV/AIDS waiver rogram: Serves individuals diagnosed with HIV/AIDS and are considered at risk for hospitalization.
- Intellectual Disabilities/Related Disabilities (ID/RD) waiver program: Serves persons diagnosed with intellectual disabilities or related disabilities and who meet the intermediate care facilities for individuals with intellectual disabilities (ICF/IID) level of care criteria.
- Mechanical Ventilator Dependent waiver program: Serves persons, 21 or older, who are dependent on mechanical ventilation and who meet a nursing facility level of care criteria.
- Medically Complex Children (MCC) waiver program: Serves children from birth to 18 who meet either nursing facility or intermediate care facilities for individuals diagnosed with intellectual disabilities (ICF/IID) level of care criteria.
- Palmetto Coordinated System of Care (PCSC) waiver program: Serves youth with significant behavioral health challenges or co-occuring conditions who are in, or at imminent risk of, out-of-home placement.
