eXPRS Glossary

Terms, Acronyms and Definitions

 

ACA (Affordable Care Act) - the federal legislation that expands Federal Medicaid funded services. Providers who receive payment for Medicaid qualifying services (such as care to individuals with I/DD), must first meet ACA standards as a valid Medicaid services provider.

ANA (Adult Needs Assessment) - an annual assessment used to determine an adult individual with I/DD’s functional service needs related to their ADL, IADL and other health related support needs. It is a tool used to determine the amount of services or number of monthly service hours an individual is eligible to receive.

“Approved to work” - a provider status definition used to indicate that a provider has completed their provider registration enrollment and has passed all the credentialing and ACA validation criteria to work as a Medicaid services provider.

Brokerage - an agency operated under contract with DHS/ODDS to provide case management/service coordination services to adults living in their own or family home.  A brokerage is a CME.

CDDP (Community Developmental Disability Program) - a program or agency operated by a local county mental health authority, or operated under sub-contract by the county with a private agency. A CDDP is a CME and serves as the centralized hub of developmental disability services in the local community. The CDDP has the responsibility to coordinate local DD services for individuals with I/DD within the specific CDDP’s geographic area in the state of Oregon. In most cases, work completed in eXPRS uses CDDP, local authority and “county” interchangeably.

CHC (Criminal History Check) - may also be referred to as a criminal background check. It is the process of reviewing a person’s criminal history to determine if they are fit to provide services to individuals with I/DD.  A CHC is often approved for a period of time (for example, 2 years). A provider must have their CHC renewed before the specified time of approval has expired to continue to qualify as a provider.

CFC (Community First Choice) - a service option that is part of Oregon’s Medicaid state plan, also known as the “K Plan Option”.  It provides for the delivery of ADL, IADL, and other health related supports to eligible individuals served by DHS.

CLE (Common Law Employer) - formerly referred to as the “employer of record” or “EOR”, this is the person who is employing a PSW to deliver an array of services to support an individual with I/DD.  Most often the CLE is simply referred to as the “employer”. In some cases, the individual with I/DD themselves will serve as their own CLE. The CLE establishes the type of service they wish the PSW to deliver, when, and where. They also maintain hire/fire authority and direct the care the individual with I/DD receives. In addition, the CLE must sign off on any services delivered reports, timesheets, or invoices verifying that the time worked as reported by the PSW was indeed for the authorized services received by the individual with I/DD.

CM (Case Management) -a more global term used to describe DD service coordination services provided by CDDP or brokerage. It also may also be included in other acronyms to more clearly identify the specific type of case management service provided to an individual with I/DD.

CME (Case Management Entity) - a general term used to describe an agency that provides case management or service coordination services to individuals with I/DD; such as a CDDP, brokerage or the CIIS program.

CMS (the Centers for Medicare & Medicaid Services) - a federal agency that administers Medicare & Medicaid programs and works in partnership with state governments to administer local Medicaid services.

DD Waiver - a common term used to refer to one or more of the TXIX home & community based services waivers for I/DD services.

DHS - the State of Oregon’s Department of Human Services.

eXPRS (Express Payment and Reporting System) - the DHS web-based, electronic service authorization & payment management system, designed for the authorization, payment and reporting of services provided to individuals with I/DD in Oregon.

eXPRS Provider ID - a multi-digit number assigned to a provider record by eXPRS when the record is initially created using the eXPRS system.

FF (Federal Funds) - used to describe service funding that is provided by the federal government.  It is also known as “TXIX matching funds.” Or “Title XIX (19) Matching Funds”

FMAS (Financial Management Agent Service) - formerly known as “FI” for “Fiscal Intermediary”, this is the ODDS contracted entity that processes payroll and issues payments to PSWs on behalf of the I/DD individual’s employer for services provided/work performed.

GF (State General Funds) - used to describe service funding that is provided by the State of Oregon.

HCBS Waiver or “DD Waiver” - a Medicaid Home & Community Based Services Waiver which outlines specific DD services for which the state is able to receive federal funding reimbursement.  It “waives” or moves federal funds previously available for institutional care and services to be used for individuals living in non-institutional (community) settings.

I/DD - acronym used for Intellectual and/or Developmental Disability.

K Plan - a common term used to describe the Community First Choice Option K of the Oregon Medicaid state plan, and is a variety of services available to individuals who are eligible for TXIX Medicaid medical assistance under the state’s Medicaid state plan. The services under this plan option include residential care, in-home attendant care, transportation, and other supportive medical services.

LOC - (Level of Care) - individual service level need evaluation and determination used to determine an individual with I/DD’s eligibility for DD TXIX Medicaid Waiver or K-Plan services.

ODDS (Office of Developmental Disability Services) - a program unit of DHS that manages, administers, oversees, and regulates all of DHS’ services to individuals with I/DD in the state.

ONA (Oregon Needs Assessment) - a single needs assessment tool used for individuals with I/DD to determine their level of service and support need. The ONA will replace the ANA and CNA assessments when the vetting & pilot of the assessment is complete.

PA (Personal Agent) - a staff person at a brokerage who is assigned a caseload of individuals with I/DD and works with them and their families to establish and manage the individual’s in-home & community support services, plans, and resources.

Pay Period - a period of time within a calendar month used to define a date range of time worked for payment to PSW providers for services delivered to individuals with I/DD. There are 2 established pay periods in a calendar month: the 1st through the 15th, and the 16th through the last day of the month.

PEAA (Provider Enrollment Application & Agreement) - a document that a provider signs as part of the provider qualification process with DHS/ODDS. The PEAA outlines the terms, conditions, requirements, and performance expectations required to be a DHS/ODDS Medicaid provider. The PEAA is valid for a limited time (2 to 5 years, depending on type of provider) and must be reviewed and resigned upon expiration to continue as a qualified provider.

POC (Plan of Care) - module in eXPRS that is a collection of different, discrete service authorizations for an individual with I/DD in a single annual plan.  A POC is a collection of multiple service authorizations.

Prime Number - a unique, alpha-numeric number assigned by DHS’ Client Index mainframe system to all individuals receiving DHS services. This number serves as the individual’s unique identifier for all DHS service related activity.

Provider - a person or agency who meets the appropriate license, certification, or other specific credential qualifications, and who is authorized or contracted to delivers an authorized I/DD service(s).

PSW (Personal Support Worker) – an individual (non-agency) provider that is employed to provide services to an individual with I/DD living in their own or family home.  PSW providers are part of the HCW-PSW-SEIU Collective Bargaining Agreement.

SD (Service Delivered entry) - a data component within an eXPRS POC that represents the date and the start/end times a POC-authorized service was provided to an individual with I/DD by a provider. This is the preliminary “timesheet” or billing data entered in eXPRS for POC services, and is used to create claims for payment back to the provider.

SNAP (Support Needs Assessment Profile) - the support needs assessment used to determine an individual’s support need and rate for DD non-relative foster care services, for both children and adults.

TXIX [Medicaid Title XIX (19)] - used to identify Medicaid funds received from the federal government for individuals or services eligible for participation in the Medicaid match funding programs. It also may refer to the portion of funding provided by the federal government for an individual’s services if they are Medicaid TXIX eligible.