Glossary of Terms
Accountability in Government Act (AGA) [6-3A-1 NMSA 1978] has a purpose to provide for more cost-effective and responsive government services by using the state budget process and defined outputs, outcomes and performance measures to annually evaluate the performance of state government programs”. © 2004 by the State of New Mexico. All rights reserved.
Administration for Children and Families (ACF) is a division of the U.S. Department of Health & Human Services. ACF promotes the economic and social well-being of children, families, individuals and communities with leadership and resources for compassionate, effective delivery of human services.
ASPEN is the Automated System Program and Eligibility Network. It is used by the Income Support Division staff to derive the office workflow and to process program eligibility for Income Support customers. ASPEN is a task-based eligibility system and workload management tool. ASPEN is linked to the New Mexico electronic case filing system which creates a task in ASPEN when a case file is uploaded.
Automated eligibility decisions describes HSD's effort to increase consistency and efficiency in processing eligibility decisions using computer automation. Use of automated systems allows staff to focus on the more complex cases that cannot be automated. Steps for automated eligibility include real time eligibility, admin renewal, auto denial/closure, and mass update.
Case Prioritization Tool (CPT) is an excel spreadsheet that has the entire inventory of the child support caseload from the Child Support Enforcement System (CSES). It is designed with filters to identify cases needing action that are provided to caseworkers to work. The filters have been designed to help improve child support performance measures. The CPT is provided monthly to all field office management and includes a fact table to show performance by field office.
Centennial Care 2.0 is the name of the New Mexico Medicaid program, which currently contracts with three Managed Care Organizations (Blue Cross Blue Shield of NM, Presbyterian Health Plan, and Western Sky Community Care). These services include physical health, behavioral health, long-term care and community benefits. Eligibility for all Medicaid programs requires that individuals meet certain federal guidelines. To apply for Centennial Care online, visit the YesNM Online Portal, create an account and follow the instructions.
Centers for Medicare &Medicaid Services (CMS) is a federal agency within the Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. Additionally, CMS has other responsibilities including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of the federal health insurance exchange.
Child Support Enforcement System (CSES) is the case management system for New Mexico. It is certified by the Federal Office of Child Support Enforcement (OCSE).
Deloitte is a consulting firm contracted with HSD for various data-related projects and services. Deloitte provides data for several of the scorecard measures that HSD’s IT Division is responsible for such as SNAP Social Impact, ASPEN eligibility system response time, and automated eligibility decisions.
DSIPT is the Delivery System Improvement Performance Targets (DSIPTs) is a tool used to measure quality improvements of Managed Care Organization (MCOs) in specific areas of the New Mexico Medicaid program. In 2020, the DSIPTs, Behavioral Health Visit with a Behavioral Health Provider and Behavioral Health Visit with a Non-Behavioral Health Provider were developed to measure clients served by both provider types. The full DSIPTs are outlined in Medical Assistance Division (MAD) Letter of Direction (LOD) number 23, which was released on January 24, 2020.
Fee-for-Service (FFS) is the traditional healthcare payment methodology where physicians and healthcare providers are paid by governments, private health insurance companies, or individuals based on the number of services provided (or the number of procedures ordered). Payments are un-bundled, meaning services are billed and paid for separately.
Healthcare Effectiveness Data and Information Set (HEDIS) measures are a national standard of 90 measures, covering 6 domains of health and healthcare including Effectiveness of Care; Access/Availability of Care; Experience of Care; Utilization and Risk; Adjusted Utilization; Health Plan Descriptive Information; and, Measures Collected Using Electronic Clinical Data Systems. The Managed Care Organization (MCO) measures in Goal 1 are part of this set. Visit the National Committee for Quality Assurance (NCQA) to learn more.
Managed Care is a healthcare delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.
Managed Care Organizations (MCOs) are health plans or insurance plans that cover an individual's healthcare needs. As of 2019, the three MCOs contracted with Centennial Care 2.0 (Medicaid in New Mexico) are Blue Cross Blue Shield of NM, Presbyterian Health Plan, and Western Sky Community Care. Molina Healthcare and United Healthcare were MCOs in previous years.
Medicaid Enrollment Report (MER) is a public report providing details on Medicaid enrollment.
Medicaid Management Information System (MMIS) is an integrated group of procedures and computer processing operations (subsystems) developed at the general design level to meet principal objectives. The objectives of this system and its enhancements include the Title XIX program control and administrative costs; service to recipients, providers, and inquiries; operations of claims control and computer capabilities; and management reporting for planning and control.
Medicaid School-Based Services (MSBS) program was added in 1994 as a Medicaid-covered benefit for children and youth age 3-20. Through this program, schools are eligible to receive reimbursement for services provided to Medicaid-eligible students that receive services under the Individuals with Disabilities Education Act (IDEA) through an Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP). Apply here.
Medication Assisted Treatment (MAT) is the use of medications, in combination with counseling to treat opioid addiction such as prescription pain relievers and heroin. The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug.
MSR report is HSD’s monthly statistical reports showing enrollment in various HSD programs and services.
New Mexico Human Services Department Programs are summarized in this overview document in English and Español
Behavioral Health Services is the Mental Health and Substance Abuse State Authority for New Mexico, and is responsible for addressing adult behavioral health need, services, planning, monitoring and quality throughout the state.
Child Support helps NM parents support their children, establishing parentage, child support and medical support orders. It also collects and disburses child support payments.
Commodity Supplemental Food Program gives out boxes of food to eligible New Mexicans aged 60 and older.
Emergency Food Assistance Program distributes food boxes to eligible lower-income individuals.
General Assistance Disability provides financial support to adults with disabilities, specifically those ineligible for federal programs.
JUST Health (Justice-Involved Utilization of State-Transitioned Healthcare) program allows inmates who are enrolled in Medicaid to have their cases suspended, rather than closed, while they are in prison or jail. Cases can then be reactivated when the individual is released.
Low Income Home Energy Assistance Program (LIHEAP) assists eligible lower-income households with their heating and cooling energy costs, bill payment assistance, energy crisis assistance, weatherization and energy-related home repairs.
Medicaid is a no-cost public health insurance program for eligible lower-income individuals. It provides coverage for doctor and hospital visits, regular check-ups, mental health services, counseling sessions, prescriptions and medical supplies. It also is the principal source of long-term care coverage for many people in the U.S.
Supporting, Training, and Employing Parents (STEPup!) program is an employment program for non-custodial parents (NCPs) who are not in compliance with their child support obligation and are unemployed or under-employed. This partnership program between the Child Support Enforcement Division and the Department of Workforce Solutions is aimed at assisting CSED customer with job development and job opportunities to assist in becoming compliant and begin making consistent child support payments to support their children. This is not a program a customer signs up for, but is referred to through their CSED caseworker.
Start Smart for Your Baby (SSFB) program is a program for pregnant and new moms, providing custom support and care for a healthy pregnancy and baby. Members can sign up to receive health education materials, such as the Mother’s Guide to Pregnancy and Guide to Life After Delivery, and guidance from a care manager throughout their pregnancy. Apply here.
Supplemental Nutrition Assistance Program (SNAP) (formerly called the Food Stamp Program) increases the food purchasing power of eligible lower-income households to help them buy a nutritionally adequate low-cost diet.
Temporary Assistance to Needy Families (TANF) program provides temporary financial assistance for pregnant people and families with one or more dependent children. TANF provides assistance to help pay for food, shelter, utilities, and expenses other than medical.
New Mexico Human Services Department websites and social media accounts
Yes New Mexico Portal: Apply for Services
Office of Child Support Enforcement (OCSE) is the federal office of child support, housed within the Administration for Children and Families at U.S. Department of Health and Human Services.
Quality Compass is a database developed by the National Committee for Quality Assurance (NCQA) that standardizes plan specific performance information and establishes guidelines for measures related to clinical performance, procedure utilization and patient experience and satisfaction. Quality Compass reports National and Regional averages which provides an opportunity to examine and compare performance outcomes across managed care plans nationally and by region. Quality Compass averages are reported for each of the 10 CMS regions as well as East, North, Central, Middle Atlantic, Mountain, New England, and Pacific. NM is assigned by CMS to Region 6 which consists of the following states: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. NM also falls within the Mountain Census region which consists of the following states: Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada and Wyoming.
Recovery Rebate Credit is authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the COVID-related Tax Relief Act. It is a tax credit against your 2020 income tax. Generally, this credit will increase the amount of your tax refund or decrease the amount of the tax you owe.
Sentiment is a term used in communications that reflects the attitude, opinions, and feelings people have about an organization's brand or identity.
SHARE HCM, the Statewide Human Resources Accounting and Reporting and Human Capital Management System, is the statewide NM government reporting system used to manage personnel information.
SHARE HCM/ASD uses a combination of data from SHARE HCM and from budget projections from HSD's Administrative Services Division.
Structured Query Language (SQL) is a computer programming language that is designed for managing data held in relational databases.
Transition of Care Plan (TOC) describes a process of transferring a patient’s care from one setting or level of care to another, such as from hospital to home or hospital to skilled nursing facility. These transitions are particularly vulnerable points in the healthcare continuum.
U.S. Department of Agriculture Food and Nutrition Services (USDA FNS) is the federal office that regulates processing of SNAP and Medicaid applications.
U.S. Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services.
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