Study guide for the final, part 8 Flashcards
CHIP is under what legislation?
Title XXI of SSA
Aspects of CHIP
Federal block grants to states to expand Medicaid eligibility
First enroll in Medicaid if qualify
No federal income threshold, but typically for children (up to age 19) in families with incomes up to 200% of federal poverty level
Purpose of CHIP
Cover children whose families’ income exceeded the Medicaid threshold levels
Reimbursement definition
Determination of methods and amounts of reimbursement in advance of delivery
Disbursement defintion
Actual payment after services have been rendered
Charge definition
A price set by provider
Rate definition
A price set by a 3rd party payer
Fee schedule definition
An index of charges listing individual fees for each type of svc
Aspects of capitation
Per member per month (PMPM) fee to cover all needed svcs
Monthly fee = PMPM rate x number of enrollees
Minimizes provider induced demand and promotes prudence
Aspects of primary care
Plays a central role in a HC delivery system
Basic, routine, continuous, coordinated and comprehensive care
An approach to delivering HC rather than a set of svcs
Address personal HC needs
Develop a partnership with pts
Practice in the context of family and community
What does primary care focus on?
Prevention
Diagnostic
Therapeutic svcs
Health education
Counseling
Minor surgery
What types of prevention does primary care include?
Primary
Secondary
Sometimes tertiary
What are the 3 elements in the WHO definition of primary care?
Point of entry
Coordination of care
Essential care: primary HC as essential HC
How is primary care a point of entry into the HC system?
The first contact a pt makes with the delivery system
Role of a gatekeeper
Aspects of coordination of care of primary care
Delivery of health svs between the pt and the different components of the delivery system
Refer pts to sources of specialized care
Give advice regarding various dx and therapies
Discuss tx options
Providing continuing care of chronic conditions
