Defining Terminology

Enrollment Broker – “A contracted statewide entity to facilitate and streamline the eligibility/enrollment process for applicants seeking services for several Pennsylvania waivers/programs. The PA Independent Enrollment Broker will work in close collaboration with service coordination providers and key stakeholders to respond to needs, address issues, and ensure participants receive prompt, high quality service.”
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Independence – “A waiver available to someone with a severe physical disability.”
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Medical Assistance – “Medical Assistance (also known as Medicaid) is a public insurance system with eligibility mainly based on income. It is jointly funded by the federal and state governments and administered by state governments. It is not “welfare” and does not provide its beneficiaries with cash assistance.”
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Medicare – “Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).”
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Medicare Advantage Plan – “A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your (hospital insurance) and (medical insurance) benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.”
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Managed Care Organization (MCO) – “A Managed Care Organization (MCO) is a health care provider or a group or organization of medical service providers who offers managed care health plans. It is a health organization that contracts with insurers or self-insured employers and finances and delivers health care using a specific provider network and specific services and products.”
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OBRA Waiver – “A Home and Community Based Waiver program that provides assistance to some people with a developmental physical disability by allowing them to live in the community and remain as independent as possible.”
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Provider – “A hospital, clinic, health care professional, or group of health care professionals who provide a service to patients.”
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‘Services My Way’ budget authority – “Allows you to manage your own budget and purchase disability related goods and services based on your needs and goals as identified during the assessment process.”
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Supports Broker – “A paid professional or agency that performs a variety of duties to support a person in self-directing services and supports.  A Support Broker can assist a person to exercise budget and employer authority to get the services and supports they need and be integrally involved in their community as they choose.”
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Service/Supports Coordination – “A critical service that involves the primary functions of locating, coordinating and monitoring needed services and supports for waiver participants. Locating services and supports consists of assistance to the participant and his or her family in linking, arranging for, and obtaining services specified in an Individual Support Plan [ISP], including needed medical, social, habitation, education or other needed community services. Activities included under the locating function include all of the following in addition to the documentation of activities.”

Telecare – “The use of computers and other telecommunication technologies to monitor patient activity and clinical findings at a distance, consult with patients and clinical colleagues and deliver health and social care to people in their own homes.”
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Waiver – “An exemption from some aspect of a federal health care statute that gives a facility the right to deliver care in a manner that varies from published standards.”
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