AFCARS - Adoption and Foster Care Analysis and Reporting System is a federally mandated
system for collecting data on children who are in foster care and children who
have been adopted under the auspices of the state's child welfare system.
AFCARS data is submitted twice a year. On April 15 to cover the period
between October 1 and March 30, and again, on October 15 to cover the period
between April 1 and September 30.
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Behavioral Health Services - Behavioral Health Services are commonly known as mental health, drug and
alcohol rehabilitation services. These include outpatient visits to the
psychiatrist, psychiatric evaluations, emergency psychiatric services, partial
hospitalization services, inpatient hospitalization services (up to 30 days),
and case management services. These also include EPSDT wraparound services.
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Capitation - Capitation is the process through which a health care practitioner, such as a
doctor or dentist, is paid a monthly or annual fee bv a managed care company to
provide as much medical or dental care to an individual as is necessary.
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CFSR - The Child and Family Services Review are designed to ensure that every state's
child welfare program and practice are in conformity with federal child welfare
requirements. The reviews focus on child and family outcomes in three domains
(safety, permanency and well-being). These domains were established by the
Adoption and Safe Families Act of 1997 (ASFA). The reviews comprise two
phases: 1) the Statewide Assessment and 2) the onsite reviews. Pennsylvania
completed its review August 26-30, 2002.
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CFSR Onsite Review - The Onsite Review component of the CFSR review process consists of an
intensive review of case practice involving the reviews of case records, key
players in each case and stakeholder groups. The team that is involved in this
review process is primarily composed of federal reviewers and state assigned
individuals. The review is held over one week. Cases are reviewed using an
instrument designed to capture information along safety, permanency and
well-being.
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Deductible - A fixed amount of money that an individual must pay before the insurance
company will begin to reimburse for services.
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Durable Medical Equipment - Medical equipment which is durable in nature, not disposable, such as
wheelchairs, lifts, hospital beds, walkers, grab bars or trapeze.
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Emergency Care - Emergency care is medical care provided after the sudden onset of a medical
condition manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical attention
could reasonably be expected to result in: a)placing the patient's health in
jeopardy; b)serious impairment to bodily functions; or c)serious dysfunction of
any bodily organ or part.
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Federal Reviews - The Children's Bureau, a division of the Administration for Children and
families of the Department of Health and Human Services, reviews state child
welfare programs through two venues: 1) the Child and Family Services Reviews
and 2) the Title IV-E Foster Care Eligibility Reviews. These reviews are
authorized by the 1994 Amendments to the Social Security Act.
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Fee-for-Service - Fee-for-service is the process of paying a health care practitioner, such as a
doctor or dentist, for each visit or procedure that happens every time an
individual sees that practitioner.
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MCO (Managed Care Organization) - A managed care organization is a health care plan designed to provide medical
services through groups of doctors, hospitals and specialty providers. Examples
of managed care organizations or plans are Health Maintenance Organizations
(HMOs), Community Health Centers and Preferred Provider Organizations (PPOs).
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Medical Necessity - Determination of medical necessity for covered care and services, whether made
on a prior authorization, concurrent, or post utilization basis, shall be in
writing, be compensable under Medical Assistance and be based on the following
standards. The plan shall base its determination on medical information
provided by the individual's family and primary care practitioner, as well as
any other providers, programs and agencies that have evaluated the individual.
Medical necessity determination must be made by qualified and trained
providers. Satisfaction of any one of the following standards will result in
authorization of the service:
The service or benefit will, or is reasonably expected to, prevent the onset of
an illness, condition or disability.
The services or benefit will, or is reasonably expected to, reduce or
ameliorate the physical, mental or developmental effects of an illness,
condition, injury or disability.
The service or benefit will assist the individual to achieve or maintain
maximum functional capacity in performing daily activities, taking into account
both the functional capacity of the individual and those functional capacities
that are appropriate for individuals of the same age.
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National Indicators - The National Data Indicators include statewide data indicators that measure
State's performance. The National Data Indicators include:
recurrence of maltreatment
incidence of child abuse and/or neglect while in foster care
incidence of foster care re-entries
stability of foster care placements
length of time to achieve reunification
length of time to achieve adoption
Through the Needs-based Budget process Pennsylvania has added a seventh
indicator which focuses on the institutionalization of children under the age
of twelve. DHS's Quality Assurance Center maintains the data on each of these
indicators for Philadelphia.
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NCANDS - National Child Abuse and Neglect Data System is a collaborative, voluntary
information collection system that gathers annual state data on abused and
neglected children. The data is submitted to the federal government on a
quarterly basis, using a calendar year framework.
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Outcomes - ASFA established the use of safety, permanency and well-being as the
appropriate ends for child welfare. Under each goal a specific set of outcomes
(results) measures was identified. Under Safety, the outcome measures are: 1)
Children are first and foremost protected from abuse and neglect 2) Children
are safely maintained in their own homes if possible. Under Permanency, the
following outcome measures are: 1) Children have permanency and stability in
their living situations. And 2) The continuity of family relationships and
connection is preserved for children. Finally, Child and Family Well-being
Outcome measures include: 1) Families have enhanced capacity to provide for
their children's needs, 2) Children receive appropriate services to meet their
educational needs and, 3) Children receive adequate services to meet their
physical and mental health needs.
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PCP (Primary Care Practitioner) - A specific physician, physician group or health center, or Certified Registered
Nurse Practitioner operating under the scope of their licensure responsible for
providing primary care services and locating, coordinating and monitoring other
medical care and rehabilitative services on behalf of a patient.
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Statewide Assessment - This part of the review was completed in Pennsylvania in February 2002. It
consists of an analysis of the state's system using seven systemic factors.
These systemic factors include: 1) the information system capacity, 2) the
case review system, 3) the quality assurance system, 4) the staff and provider
training system, 5) service array and resource development, 6) the agency's
responsiveness to the community, and 7) foster home and adoptive homes
recruitment, licensing and approval. Another segment of the Statewide
Assessment includes data on the status of children at given points. Other
areas of the assessment include a narrative that explains the state's outcomes
in each of the outcomes, and identification of strengths and weaknesses.
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Third-Party Reimbursement - Payment of medical services by an entity other than the individual receiving
the services or the provider who provides the service. An example of
third-party reimbursement is payment by an insurance company or the Federal
government under the Medicare program to a provider. The third party is not
directly involved with the delivery of service.
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Urgent Care - Urgent care is any illness, injury or severe condition which under reasonable
standards of medical practice would be diagnosed and treated within a 24-hour
period and if left untreated, could rapidly become a crisis or emergency
situation. Additionally, it includes situations such as when a person's
discharge from a hospital will be delayed until services are approved or a
person's ability to avoid hospitalization depends upon prompt approval of
services.
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