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Health Care Reform Glossary

Here are some helpful health care reform terms and acronyms. If you are interested in learning more, click on the term in green.

TERM ACRONYM DEFINITION
Accountable Care Organization ACO ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated care to their Medicare patients. The goal is to ensure patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
Actuarial Value AV The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.
Affordable Care Act ACA The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.
The Center for Consumer Information & Insurance Oversight CCIIO The Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight (CCIIO), part of the Department of Health & Human Services (DHHS), provides national leadership in setting and enforcing standards for health insurance that promote fair and reasonable practices to ensure that affordable, quality health coverage is available to all Americans. The center also provides consumers with comprehensive information on coverage options currently available so they may make informed choices on the best health insurance for their family.
Centers for Medicare & Medicaid Services CMS The HHS agency responsible for Medicare and parts of Medicaid. CMS is responsible for oversight of HIPAA administrative simplification transaction and code sets, health identifiers, and security standards. CMS also maintains the HCPCS medical code set and the Medicare Remittance Advice Remark Codes administrative code set.
Consumer Oriented and Operated Health Plan CO-OP A non-profit organization in which the same people who own the company are insured by the company. Cooperatives can be formed at a national, state, or local level and can include doctors, hospitals, and businesses as member-owners. Under the ACA, low-interest loans were awarded to help non-profit groups to help set up and maintain issuers. 24 non-profits offering coverage in 24 states have been awarded loans. The Kaiser Family Foundation has a list of the new CO-OPS.
Department of Health and Human Services HHS The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
Essential Health Benefits EHB A comprehensive set of health care items and services that must be covered by certain plans, starting in 2014.
Federal Poverty Level FPL A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits. With the new health insurance marketplaces, the FPL will be used to help determine financial aid and subsidies when purchasing coverage through an exchange.
Federally-Facilitated Exchange FFE Any State that does not elect to operate a State based Exchange will have a federal government run insurance exchange which will be operated by the United States Department of Health and Human Services (HHS).
Full-Time Equivalent FTE The total number of regular straight-time hours worked (i.e., not including overtime or holiday hours worked) by employees divided by the number of compensable hours applicable to each fiscal year. Annual leave, sick leave, compensatory time off and other approved leave categories are considered “hours worked” for purposes of defining full-time equivalent employment
Health Insurance Exchange/Marketplace HIX A resource where individuals, families, and small businesses can learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. The Marketplace also provides information on programs that help people with low to moderate income and resources pay for coverage. This includes information about other programs, including Medicaid and the Children’s Health Insurance Program (CHIP). The Marketplace is accessible through websites, call centers, and in-person assistance.
Metropolitan Statistical Area MSA A geographic entity delineated by the Office of Management and Budget for use by federal statistical agencies. Metropolitan statistical areas consist of the county or counties (or equivalent entities) associated with at least one urbanized area of at least 50,000 population, plus adjacent counties having a high degree of social and economic integration with the core as measured through commuting ties. Each state has a set number of Geographic rating areas that are used to help determine premiums. The default geographic rating areas for each state will be the number of MSAs+1.
Patient Protection and Affordable Care Act PPACA The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.
Qualified Health Plan QHP Under the Affordable Care Act, starting in 2014, an insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements. A qualified health plan will have a certification by each Marketplace in which it is sold.
Small Business Health Options Program SHOP The Small Business Health Options Program (SHOP) is designed for small employers with 50 or fewer full-time equivalent employees. With one online application, on your own or with the help of an agent, broker, or other assister, you can compare price, coverage, and quality of plans in a way that’s easy to understand.