Glossary

Maintenance or personal care services

Also called custodial care. Any care where the main reason for the service is to assist someone in need of care because he or she has a chronic illness or disability.

Managed care

Method of organizing and financing healthcare services that emphasizes cost-efficiency and coordination of care. Managed care organizations (including HMOs, PPOs and PSOs) receive a fixed amount of money per client/member per month (called a capitation), no matter how much care a member needs during that month.

Marketbasket index

An inflationary index reflecting the annual change in prices of goods and services used by providers to deliver healthcare. Similar to the consumer price index. Federal authorities, for example, annually recommend and approve marketbasket updates (increases or decreases) to base Medicare reimbursement rates.

Maximum lifetime benefit

This is the maximum amount of benefits that an insurance policy will pay.

MDS (Minimum Data Set)

A core set of screening and assessment elements for all individuals residing in Medicare or Medicaid covered long-term care facilities. The comprehensive form includes common definitions and coding categories, which form the foundation for a resident’s overall assessment. Items standardize communication about resident problems and conditions within facilities, between facilities and outside agencies.

MDS coordinator

A facility employee, usually a licensed nurse, responsible for making sure residents’ MDS forms and care plans are completed promptly and coded accurately.

Means test

Measures of income and assets to determine a person’s eligibility for some government benefit programs such as Medicaid.

Medicaid (Title XIX)

Federal and state-funded program of medical assistance to low-income individuals of all ages. Income eligibility requirements apply for Medicaid.

Medicaid-certified bed

A nursing facility bed in a building or part of a building that meets federal standards for serving Medicaid recipients.

Medical ancillary index

The index applied to the RUG to calculate the PPS rate.

Medical insurance (Medicare Part B)

Medical insurance that helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover (such as some home healthcare). Part B helps pay for these covered services and supplies when they are medically necessary. A monthly premium must be paid to receive Part B.

Medical necessity

Services or supplies deemed to be appropriate and consistent with the diagnosis, and in accord with accepted standards of community practice. Not experimental services or supplies. They also cannot be omitted without harming an individual's condition or the quality of medical care.

Medical records director/coordinator

Coordinates the management of resident medical records and the clerical needs of the nursing department.

Medically indigent

This label applies to individuals who cannot afford needed healthcare.

Medicare (Title XVIII)

Federal health insurance program for people 65 and older, as well as certain disabled individuals of any age. Consists of three parts: Part A (hospital insurance), Part B (optional medical insurance that covers physicians' services and outpatient care in part; requires a monthly payment); and Part D (prescription benefit program).

Medicare HMOs

Under Medicare HMOs (health maintenance organizations), members pay regular monthly premiums to Medicare, and Medicare pays the HMO a fixed sum to provide Medicare benefits (such as hospitalization, doctor's visits, etc.). Medicare HMOs may provide extra benefits over and above regular Medicare benefits (such as eyeglasses, among others). Members do not pay Medicare deductibles and co-payments but may have to pay the HMO various additional fees.

Medicare Part A

Hospital insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care, and some home health care. Most people get Medicare Part A automatically when they turn 65.

Medicare Part B

Medical insurance that helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover (such as some home healthcare). Part B helps pay for these covered services and supplies when they are medically necessary. A monthly premium must be paid to receive Part B.

Medicare Part D

The federally funded prescription drug benefit, the newest addition to the Medicare program. Transferred many coverage duties from Medicaid. Requires specific enrollment choices.

Medicare Supplement Insurance (MedSupp)

Also called Medigap. Insurance supplement to Medicare that is designed to fill in the "gaps" left by Medicare (such as copayments). May pay for some limited long-term care expenses, depending on the benefits package purchased.

Medicare-certified bed

A nursing facility bed in a building or part of a building that meets federal standards for serving Medicare residents requiring skilled nursing care.

Medigap

Also called Medicare supplement insurance. Insurance supplement to Medicare that is designed to fill in the "gaps" left by Medicare (such as copayments). May pay for some limited long-term care expenses, depending on the benefits package purchased.

Mental health

The capacity in an individual to function effectively in society. Mental health is a concept influenced by biological, environmental, emotional, and cultural factors and is highly variable in definition, depending on time and place. It is often defined in practice as the absence of any identifiable or significant mental disorder.

Mental health services

Variety of services provided to people of all ages, including counseling, psychotherapy, psychiatric services, crisis intervention and support groups. Issues addressed include depression, grief, anxiety and stress, as well as severe mental illnesses.

Mental illness/impairment

A deficiency in the ability to think, perceive, reason or remember, resulting in loss of the ability to take care of one's daily living needs.

Minimum Data Set – see MDS