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Glossary of Terms



Activities of Daily Living (ADLs, ADL)
- An individual's daily habits such as bathing, dressing and eating. ADLs are often used as an assessment tool to determine an individual's ability to function at home, or in a less restricted environment of care.


Acute Care - A pattern of health care in which a patient is treated for an acute (immediate and severe) episode of illness, for the subsequent treatment of injuries related to an accident or other trauma, or during recovery from surgery. Specialized personnel using complex and sophisticated technical equipment and materials usually give acute care in a hospital. Unlike chronic care, acute care is often necessary for only a short time.


Advance Directive - A legal document outlining medical decisions to be made for a person should he or she not be fully capable of deciding for themselves due to the nature of his or her injury or illness. These directives can include Living Wills or Durable Power of Attorney.


Assisted Living - Broad range of residential care services, but does not include nursing services. Normally lower in cost than nursing homes.


CCRC (Continuing Care Retirement Community) - A campus or community that provides multiple levels of care to residents based on their needs, including independent living, assisted living or skilled nursing care. Residents can move from one level to another based on their needs without having to travel far.


Caregiver - A person who is providing care for someone recovering from an illness, injury or disease.


Case Manager - A nurse, doctor, or social worker who works with patients, providers and insurers to coordinate all services deemed necessary to provide the patient with a plan of medically necessary and appropriate health care.


Census - (Occupancy Rate) - A measure of inpatient health facility use, determined by dividing available bed days by patient days. It measures the average percentage of a hospital's beds occupied and may be institution-wide or specific for one department or service.


Centers for Medicare and Medicaid Services (CMS) - The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Programs for which CMS is responsible include Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), HIPAA and CLIA. Formerly was HCFA. Centers for Medicare & Medicaid Services has historically maintained the UB-92 institutional EMC format specifications, the professional EMC NSF specifications, and specifications for various certifications and authorizations used by the Medicare and Medicaid programs. 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.


Discharge Planning - Required by Medicare and JCAHO for all hospital patients. A procedure where aftercare services are determined for after discharge from the inpatient facility.


Durable Power of Attorney - A legal document that designates a specific individual to act on a person's behalf should they become disabled or incapacitated.


Entititlements - Various federal and state government programs that provide financial benefits or services to people who meet specific eligibile conditions. Entitlement programs include Social Security, Medicare, Medicaid, and more.


HMO (Health Maintenance Organization) - A type of care plan where a person receives health benefits from a specific network of doctors, hospitals, and other health care providers who receive compensation from a specific insurance company or entitlements program.


Health Insurance Portability and Accountability Act of 1996 (HIPAA) - A Federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. This legislation sets a precedent for Federal involvement in insurance regulation. It sets minimum standards for regulation of the small group insurance market and for a set group in the individual insurance market in the area of portability and availability of health insurance. As a result of this law, hospitals, doctors and insurance companies are now required to share patient medical records and personal information on a wider basis. This wide-based sharing of medical records has led to privacy rules, greater computerization of records and consumer concerns about confidentiality. In addition, HIPAA required the creation of a federal law to protect personally identifiable health information; if that did not occur by a specific date (which it did not), HIPAA directed the Department of Health and Human Services (DHHS) to issue federal regulations with the same purpose. DHHS has issued HIPAA privacy regulations (the HIPAA Privacy Rule) as well as other regulations under HIPAA. HIPAA gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information. Also known as the Kennedy-Kassebaum Bill, the Kassebaum-Kennedy Bill, K2, or Public Law 104-191.


Hospice Care - An array of services that provides care for terminally ill patients. Hospice Care also provides support and counseling for families as well. Also see Palliative Care.


Independent Living - A facility for seniors who are healthy, mobile and capable of living on their own. Independent Living Facilities may also offer some level of care should residents need it.


Inpatient Care - Health care provided to an individual in a hospital or other institutional setting.


Length of Stay (LOS) - The duration of an episode of care for a covered person. The number of days an individual stays in a hospital or inpatient facility. May also be reviewed as Average Length of Stay (ALOS).


Long-term Care (LTC) - A set of health care, personal care and social services required by persons who have lost, or never acquired, some degree of functional capacity (e.g., the chronically ill, aged, disabled, or retarded) in an institution or at home, on a long-term basis. The term is often used more narrowly to refer only to long-term institutional care such as that provided in nursing homes, homes for the retarded and mental hospitals. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Most long-term care is custodial care. Medicare doesn’t pay for this type of care if this is the only kind of care a person needs. However, Medicaid and long-term care insurance plans do provide some coverage for long-term care. Ambulatory services such as home health care, which can also be provided on a long-term basis, are seen as alternatives to long-term institutional care.


Long-term Care Insurance - Insurance designed to pay for some or all of the costs of long term care.


Managed Care - Systems and techniques used to control the use of health care services. Includes a review of medical necessity records, incentives to use certain providers, and case management. The body of clinical, financial and organizational activities designed to ensure the provision of appropriate health care services in a cost-efficient manner. Managed care techniques are most often practiced by organizations and professionals that assume risk for a defined population (e.g., health maintenance organizations) but this is not always the case. Managed care is a broad term and encompasses many different types of organizations, payment mechanisms, review mechanisms and collaborations. Managed care is sometimes used as a general term for the activity of organizing doctors, hospitals, and other providers into groups in order to enhance the quality and cost-effectiveness of health care. Managed Care Organizations (MCO) include HMO, PPO, POS, EPO, PHO, IDS, AHP, IPA, etc. Usually when one speaks of a managed care organization, one is speaking of the entity that manages risk, contracts with providers, is paid by employers or patient groups, or handles claims processing. Managed care has effectively formed a "go-between," brokerage or 3rd party arrangement by existing as the gatekeeper between payers and providers and patients. The term managed care is often misunderstood, as it refers to numerous aspects of healthcare management, payment and organization. It is best to ask the speaker to clarify what he or she means when using the term "managed care." In the purest sense, all people working in healthcare and medical insurance can be thought of as "managing care." Any system of health payment or delivery arrangements where the plan attempts to control or coordinate use of health services by its enrolled members in order to contain health expenditures, improve quality, or both. Arrangements often involve a defined delivery system of providers with some form of contractual arrangement with the plan.


Medicaid (Title XIX) - A joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid serves the poor, blind, aged, disabled or members of families with dependent children (AFDC). Each state has its own standards for qualification. A federally aided, state-operated and administered program that provides medical benefits for certain indigent or low-income persons in need of health and medical care. The program, authorized by Title XIX of the Social Security Act, is basically for the poor. It does not cover all of the poor, however, but only persons who meet specified eligibility criteria. Subject to broad federal guidelines, states determine the benefits covered, program eligibility, rates of payment for providers, and methods of administering the program. Medicaid programs vary from state to state, but most health care costs are covered for citizens who qualify for both Medicare and Medicaid. All states but Arizona have Medicaid programs.


Medicare (Title XVIII) - A federal program for the elderly and disabled, regardless of financial status. It is not necessary, as with Medicaid, for Medicare recipients to be poor. A U.S. health insurance program for people aged 65 and over, for persons eligible for social security disability payments for two years or longer, and for certain workers and their dependents who need kidney transplantation or dialysis. Monies from payroll taxes and premiums from beneficiaries are deposited in special trust funds for use in meeting the expenses incurred by the insured. It consists of two separate but coordinated programs: hospital insurance (Part A) and supplementary medical insurance (Part B) - and a separate drug coverage program administered by the private sector (Part D). Medicare covers more than 16% of population. It is the largest insurance program or health plan in the US. See also CMS.


Medicare Part A - The Medicare component that provides basic hospital insurance to cover the costs of inpatient hospital services, confinement in nursing facilities or other extended care facilities after hospitalization, home care services following hospitalization, and hospice care.


Medicare Part B - The Medicare component that provides benefits to cover the costs of physicians' professional services, whether the services are provided in a hospital, a physician's office, an extended-care facility, a nursing home, or an insured's home.


Medicare Part D - A program to aid with the costs of prescription drug expenses for Medicare beneficiaries.


Medicare Prescription Drug Plan (PDP or MPDP) - A stand-alone drug plan, offered by insurers and other private companies to beneficiaries that receive their Medicare Part A and/or B benefits through the Original Medicare Plan; Medicare Private Fee-for-Service Plans that don’t offer prescription drug coverage; and Medicare Cost Plans offering Medicare prescription drug coverage. These stand-alone plans add prescription drug coverage to the Original Medicare Plan and to some Medicare Cost Plans and Medicare Private Fee-for-Service Plans. Managed by commercial and private entities, these PDPs are a type of managed care. When people join a Medicare Prescription Drug Plan, they use the plan member cards when purchasing prescriptions. When they use their cards, they will normally get discounts on their prescriptions, provided that the drugs are on the approved or covered lists and they are not operating within the "donut hole." Costs will vary depending on recipients' financial situations and which Medicare Prescription Drug Plans they chose. If an individual has limited income and resources, he or she may get extra help to cover prescription drugs for little or no cost. All MPDPs are not the same and will have varying costs, benefits, doctor choices, conveniences, and quality.


Medigap - A Medicare supplement insurance policy sold by private insurance companies to cover areas that are not covered by typical Medicare plans.


Nutritional Management - A care service designed to assist patients with a balanced diet.


Occupational Therapy - Treatment given to help with resuming everyday activities such as bathing, preparing meals and housekeeping following an injury or illness.


Outpatient Care - Care given to a person who is not bedridden; also called ambulatory care. Many surgeries and treatments are now provided on an outpatient basis, while previously this had been considered the reason for inpatient hospitalization. Some say this is the fastest growing segment of healthcare.


Pain Management - A care service designed to assist patients with the prevention and treatment of pain.


Palliative Care - An array of services that provides care for terminally ill patients. Palliative Care also provides support and counseling for families as well. Also see Hospice Care.


Physical Therapy - Treatment of injury and disease via exercise, massage and other physical activities.


Post-Acute Care - Medical care specifically designed to help a patient recover after a hospital stay.


Public Aid - An entitlements program where the government provides financial benefits to the poor, elderly, or disabled


Referral - The process of sending a patient from one practitioner to another for health care services. Health Plans may require that designated primary care providers authorize a referral for coverage of specialty services. Normally, this type of referral means a written order from the enrollee's primary care doctor for the enrollee to see a specialist or get certain services. In many HMOs or Health Plans, an enrollee must get a referral before the enrollee can get care from anyone except the primary care doctor. Without a formal referral, the plan may not pay for the care.


Rehabilitation - Rehabilitative services are normally ordered by a doctor to help a patient recover from an illness or injury. These services are given by nurses and physical, occupational, and speech therapists. Examples include working with a physical therapist to help a patient walk after surgery or working with an occupational therapist to help a patient learn how to get dressed after a stroke.


Respite Care - A care service designed to give the everyday caregiver a rest or break from providing care for their loved one. Nursing homes, assisted living facilities, and other long-term care facilities provide this service, caring for the loved one for a short period of time.


Restorative Nursing - A nursing program designed to assist persons who have a debilitating illness or injury. These programs help to restore the persons abilities so they can continue the healing process.


Secondary Coverage - Health plan that pays costs not covered by primary coverage under coordination of benefits rules. Any insurance that supplements Medicare coverage. The three main sources for secondary insurance are employers, privately purchased Medigap plans, and Medicaid.


Skilled Care - A type of health care given when a patient needs skilled nursing or rehabilitation staff to manage, observe, and evaluate care. Generally refers to a level of care that is lower, or less intense, than inpatient hospital care.


Skilled Nursing Care - A level of care that includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).


Skilled Nursing Facility (SNF) - A licensed institution, as defined by Medicare, which is primarily engaged in the provision of skilled nursing care. SNFs are usually DRG or PPS exempt and are located within hospitals, but sometimes are located in rehab facilities or nursing homes. SNFs provide a level of care that requires the daily involvement of skilled nursing or rehabilitation staff and that, as a practical matter, can’t be provided on an outpatient basis. Examples of skilled nursing facility care include the provision of such services as intravenous injections and physical therapy. The need for custodial care (for example, assistance with activities of daily living, like bathing and dressing) may not, in itself, qualify for reimbursement in a skilled nursing facility by Medicare or other health plans.


Speech Therapy - Treatment to regain and strengthen speech skills typically following a stroke or other neurological injuries.


Sub-Acute Care - An inpatient care service for those recovering from an illness, injury, or disease who do not need to be treated for immediate or acute conditions.


Transitional Care - A care service designed to provide health care to a patient during a transition from one healthcare setting to another, typically at a hosptal, skilled nursing facility or the patient's home.


TriCare - A health care program for active duty and/or retired uniformed service members, as well as their families.

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Terms of Use

website.com ("Site")

TERMS AND CONDITIONS OF USE

Welcome to the Site. The Site is provided to you for your personal entertainment, information, education and communication through our featured content and interactive forums on the World Wide Web.

Please read these Terms and Conditions carefully. These Terms and Conditions include our policy for acceptable use of the Site and content posted on the Site, your rights, obligations and restrictions regarding your use of the Site and the Site's Privacy Policy found here.

By accessing this Site, you accept, without limitation or qualification, the following Terms and Conditions. You are only authorized to use the Site and its services if you agree to abide by all applicable laws and to these Terms and Conditions. If you do NOT accept the Terms and Conditions, then please discontinue your use of the Site.

We may modify these Terms and Conditions from time to time and such modification shall be effective upon posting on the Site. You agree to be bound to any changes to these Terms and Conditions when you use the Site after any such modification is posted. Is it important that you review these Terms and conditions regularly to ensure you are updated as to any changes made. These Terms and Conditions constitute the entire agreement regarding your use of the Site and the services it offers and supercede any such prior terms.

Without limiting any other provisions of this Agreement, you may not use this Site for any purpose that is unlawful or prohibited by this Agreement and/or any applicable additional terms. Your access to this Site may be terminated immediately in our sole discretion, with or without notice, if you fail to comply with any provision of this agreement and/or additional terms, or for any other reason, or no reason. You expressly agree not to:

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Without limiting the foregoing, the following behaviors are strictly prohibited:

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Links

The Site may provide links to other websites or resources. Because we have no control over such sites and resources, you acknowledge and agree that we are not responsible for the availability of such external sites and resources, and do not endorse and is not responsible or liable for any content, advertising, products or other materials on or available from such sites or resources. You further acknowledge and agree that we shall not be liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with the use or reliance on any such content, goods or services available on or through any such site or resource.

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Pursuant to 47 U.S.C. Section 230 (d) as amended, we hereby notify you that parental control protections (such as computer hardware, software, or filtering services) are commercially available that may assist you in limiting access to material that is harmful to minors. Information identifying current providers of such protections is available at the American Links Up web site, http://www.netparents.org.

Infringement Policy

Pursuant to 17 U.S.C. Section 512 as amended by Title II of the Digital Millennium Copyright Act (the "Act"), we reserve the right, but not the obligation, to terminate your license to use the Site if we determine in its sole and absolute discretion that you are involved in infringing activity, including allege acts of first-time or repeat infringement, regardless of whether the material or activity is ultimately determined to be infringing. We accommodate and do not interfere with standard technical measures used by copyright owners to protect their materials. In addition, pursuant to 17 U.S.C. Section 512 (c), we have implemented procedures for receiving written notification of claimed infringements and for processing such claims in accordance with the Act. All claims of infringement must be submitted in a written complaint that complies with the requirements below and delivered to our designated agent to receive notification of claimed infringement by mail:

The Legal Department
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You agree to indemnify and hold us, and our subsidiaries, affiliates, directors, officers, agents, vendors or other partners and employees harmless from any claim or demand, including attorneys' fees, made by any third party due to or arising out of any material or information posted, provided, transmitted or otherwise made available by you on the Site or through the Site's services, or by your violation of these Terms and Conditions, or by your violation of the rights of another.

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IN NO EVENT SHALL THE SITE OR ITS OWNER BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY INDIRECT, CONSEQUENTIAL, EXEMPLARY, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING LOST PROFIT DAMAGES ARISING FROM YOUR USE OF THE SITE OR ITS SERVICES EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

Some jurisdictions do not allow the disclaimer, exclusion or limitation of incidental or consequential damages, so the foregoing disclaimer, exclusion and limitation may not apply to you, and you may have other legal rights that vary according to jurisdiction. In no event will damages provided by law (if any) apply unless they are required to apply by statute, notwithstanding their exclusion by contract.

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We make no representation that materials on the Site are appropriate or available for use in other locations, and accessing them from territories where their content is illegal is prohibited. Those who choose to use or access the Site from other locations do so on their own initiative and are responsible for compliance with local laws.

The section titles and other headings in these Terms and Conditions are for convenience only and have no legal or contractual effect. Our failure to exercise or enforce any right or provision of these Terms and Conditions shall not operate as a waiver of such right or provision. If any provision of these Terms and Conditions is unlawful, void or unenforceable, that provision is deemed severable and does not affect the validity and enforceability of any remaining provisions.

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Privacy Policy

Your privacy is important to us, and we are committed to protecting the information you choose to share with us. For this reason, Rosewood maintains the following privacy policy.

We gather contact information you voluntarily provide, via applications or surveys needed to fulfill your requests (for example, your business addresses, phone and fax numbers, firm affiliations and titles). We use the information you share with us to provide you information about services or products you have requested or to inform you of relevant products, services or upcoming events and programs that might be of interest.

We keep all information you choose to share with us completely secure and will never share, sell or otherwise provide any information about you to any third party.

We maintain security procedures and standards which we believe are as safe as today's technology permits. We test these procedures and modify them regularly as new technologies become feasible.

We utilize a strict Opt-Out Policy for sending online notifications regarding services, products and programs. If you do not wish to receive e-mails from us, please Click Here, fill in your information and put “opt out” in the comments.

- Revised 05.18.11

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