A
| Terms | Definitions |
|---|---|
Access | The extent to which an individual who needs care and services is able to receive them. Access is more than having insurance coverage or the ability to pay for services. It is also determined by the availability of services, acceptability of services, cultural appropriateness, location, hours of operation, transportation needs, and cost. |
| Accessible Services | Services that are affordable, located nearby, and open during evenings and weekends. Staff is sensitive to and incorporates individual and cultural values. Staff is also sensitive to barriers that may keep a person from getting help. For example, an adolescent may be more willing to attend a support group meeting in a church or club near home than to travel to a mental health center. An accessible service can handle consumer demand without placing people on a long waiting list. |
| Accreditation | An official decision made by a recognized organization that a health care plan, network, or other delivery system complies with applicable standards. |
| Activity Therapy | Includes art, dance, music, recreational and occupational therapies, and psychodrama. |
| Admissions | The number of persons admitted, readmitted, or transferred to a specified service during the reporting period. |
| Administrative Costs | Costs not linked directly to the provision of medical care. Includes marketing, claims processing, billing, and medical record keeping, among others. |
| Adverse Selection | Occurs when Plan enrollees include a higher percentage of high-risk individuals than are in the average population, resulting in the potential for greater health care utilization and therefore increased costs. |
| Alternative Therapy | An alternative approach to mental health care is one that emphasizes the interrelationship between mind, body, and spirit. Although some alternative approaches have a long history, many remain controversial. |
| ALERT | Algorithms for Effective Reporting and Treatment; ALERT), which is a consumer-directed, outcomes based and cost-effective approach to making treatment decisions and controlling outpatient costs. ALERT includes both Member-centered and Provider-Centered management algorithms. |
| Anorexia Nervosa | Anorexia nervosa is an eating disorder characterized by unusual eating habits such as avoiding food and meals, picking out a few foods and eating them in small amounts, weighing food, and counting the calories of all foods. Individuals with anorexia nervosa may also exercise excessively. |
| Anxiety Disorders | Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder. |
| Any Willing Power | A requirement that a health plan contract for the delivery of health care services with any provider in the area who would like to provide such services to the plan's enrollees according to the terms offered by the health plan. |
| Appeal | A request for reconsideration of a decision by the health plan about services. |
| Appropriateness | he extent to which a particular procedure, treatment, test, or service is clearly indicated, not excessive, adequate in quantity, and provided in the setting best suited to a patient's or member's needs. (See also, Medically Necessary). |
| Appropriate Services | Designed to meet the specific needs of each individual child and family. For example, one family may need day treatment, while another may need home-based services. Appropriate services for one child and family may not be appropriate for another. |
| Assessment | A professional review of child and family needs that is done when services are first sought from a caregiver. The assessment of the child includes a review of physical and mental health, intelligence, school performance, family situation, and behavior in the community. The assessment identifies the strengths of the child and family. Together, the caregiver and family decide what kind of treatment and supports, if any, are needed. |
| Attention-Deficit/Hyperactivity Disorder (ADHD) | Attention-deficit/hyperactivity disorder, sometimes called ADHD, is a chronic condition and the most commonly diagnosed behavioral disorder among children and adolescents. It affects between 3 and 5 percent of school-aged children in a 6-month period (U.S. Department of Health and Human Services, 1999). Children and adolescents with attention-deficit/hyperactivity disorder have difficulty controlling their behavior in school and social settings. They also tend to be accident-prone. Although some of these young people may not earn high grades in school, most have normal or above-normal intelligence. |
| Autism | Autism, also called autistic disorder, is a complex developmental disability that appears in early childhood, usually before age 3. Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development. |
| Auto-Enrollment | The automatic assignment of a person to a health insurance plan (typically done under Medicaid plans). |
| Average Length Of Stay | This represents the average time a client receives a specified service during a specified time period. This is generally computed by counting all the days that clients received the service during the time period and dividing by the number of clients that received the service during the same period. (Days a person was on furlough or not receiving services are not counted.) |
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