Client Data  > 2000 > Glossary

Glossary Fiscal Year 2000 - Medical Assistance Administration

Medical Assistance Administration (MAA) assures that necessary medical care is available to income Assistance and other eligible low income persons. Medical Assistance-paid services include fee-for-service payments and managed health care premiums. Medical Assistance-paid services also include primary care case management clients, regardless of whether they received fee-for-service services. Through the provision of Medicaid services, MAA uses both federal and state funds to pay for services to Categorically Needy clients, those meeting categorical and income eligibility requirements set by the federal government for income Assistance services; and to Medically Needy clients, those meeting categorical eligibility requirements but with assets and/or incomes slightly higher than the allowable limits. Categorically Needy clients include pregnant women in Washington State who are at or below 185 percent of the federal poverty level as well as Medicaid eligible children under the age of 19 with family incomes at or below 200 percent of the federal poverty level. Under the Refugee Act of 1980 the federal government pays for services provided to refugees in their first 8 months in the United States. In addition to federally-funded services, Washington State covers the cost of services to non-Medicaid eligible children under the age of 18 with family incomes below 100 percent of the federal poverty level, to non-Medicaid eligible clients receiving GA-U, and to clients receiving Medically Indigent services.

Clients eligible for either Title XIX or non-Title XIX medical Assistance may receive one or more of the following types of care:

Hospital Inpatient Care: Hospital Inpatient Care includes care and treatment to clients admitted to stay at a facility under the direction of a physician or dentist. A licensed or formally approved hospital furnishes these services. These services include emergency room care provided to clients admitted through the emergency room to an inpatient stay. Hospital Inpatient Care also includes room and board and other ancillary services such as drugs, laboratory, and radiology.

Emergency Room Care (Hospital Outpatient and Physician Care Only): These services include care furnished by a licensed or approved hospital to clients who receive emergency room treatment but who are not admitted to stay at the facility. A provider of ER Physician Care is, or is under the personal supervision of, an individual licensed to practice medicine or osteopathy. These services include only Hospital Outpatient and Physician Care for which an emergency room charge appears on the claim.

Hospital Outpatient Care: A licensed or approved hospital provides Hospital Outpatient Care to clients treated, but not admitted to stay, at the facility. These services do not include Emergency Room Hospital Outpatient Care. Physician care provided in outpatient clinics is categorized with Physician and Clinic Care.rovided in outpatient clinics is categorized with Physician and Clinic Care.

Physician and Clinic Care: A provider of Physician Care is, or is under the personal supervision of, an individual licensed to practice medicine or osteopathy. Providers furnish Physician Care in the physician's office, the client's home, a hospital, or elsewhere. Indian Health Clinics and Rural Health Clinics furnish Clinic Care. Physician and Clinic Care includes primary care case management furnished by these providers.

Psychiatric Care: Licensed psychiatrists or, on a very limited basis, psychologists provide Psychiatric Care. Psychiatric Care does not include Emergency Room Psychiatric Services. ER Psychiatric Services are categorized with Emergency Room Care.

Prescription Drugs: These include simple or compound substances or mixtures prescribed by a physician or other licensed practitioner and dispensed by licensed pharmacists or other authorized practitioners.

Dental Services: These include diagnostic, preventive, or corrective services provided by or under the supervision of an individual licensed to practice dentistry or dental surgery.

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services include preventive health care for children provided in four distinct components: health screening, dental services, vision exams, and hearing exams. If the screenings identiFiscal Year a medical or dental problem, Medicaid pays for the necessary treatment, regardless of whether or not the service is in the State Plan.

Managed Health Care Payments: Managed Health Care Payments are fixed monthly premiums paid on a per client basis to managed health care providers. In return for the payment, a managed health care provider makes a range of services available to the client. The one-time payment is independent of the client's use of those services and replaces the traditional fee-for-service arrangement. Health maintenance organizations, which provide services through staff physicians; or health insuring organizations, which contract with primary care physicians to provide services, administer managed health care plans.

Medicare Premium Payments: Premiums pay for Medicare insurance coverage for eligible clients. Medicare premiums are for either Medicare Part A or for Medicare Part B insurance. Medicare Part A insurance covers, among other things, hospital and nursing home services. Medicare Part B insurance covers, among other things, physician, ambulance, and durable medical equipment services, but does not cover prescription drugs.

Other Medical Services: Other Medical Services includes durable medical equipment, home health care, hospice care, maternity case management, medically necessary transportation, optometrists, opticians and eyeglasses, chiropractic care, oxygen, hearing aids, and a variety of other services that represent a small proportion of MAA expenditures..

Client Service Database (CSDB) for Fiscal Year 99 reports the number of persons eligible to receive Medical Assistance. NADB for Fiscal Year 94 reported detailed encounter information for the following:

• Hospital Inpatient Care

• Emergency Room Care (Outpatient and Physician Care)

• Hospital Outpatient Care

• Physician and Clinic Care

• Psychiatric Care

• Prescription Drugs

• Dental Services

• Early Periodic Screening, Diagnosis, Treatment (EPSDT)

• Managed Health Care Payments

• Medicare Premium Payments

• Other Medical Services

Counts for "Medically Eligible Clients" in CSDB for Fiscal Year 99 were reported in a single category comprised of both those clients eligible for Title XIX Assistance and those eligible for non-Title XIX Assistance. In CSDB for Fiscal Year 00, clients eligible for medical Assistance are reported in two categories: (1) Medically Eligible Clients (Title XIX Assistance) and (2) Medically Eligible Clients (non-Title XIX Assistance).

• Medically Eligible Clients (Title XIX). Clients who receive medical services for which the state receives federal Title XIX matching funds. funds.

• Medically Eligible Clients (non-Title XIX). Clients who receive medical services which are solely state-funded.

Source: CSDB  -  State Fiscal Year 2000

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