Commonly Used Definitions
Care Coordinator – an individual/agency approved by the State to assist families in submitting a TEFRA application. Contacting a care coordinator is a vital part of the TEFRA process. The care coordinator is responsible for gathering all the necessary documents and submitting them in a timely manner to the DPA, DDS, DSDS and Qualis Health for review on your behalf.
Cost of Care (COC) – a form that is required as part of a TEFRA application that gives the details of the yearly costs of services being provided for the applicant/child.
Denali Kid Care (DKC) – is a State of Alaska program designed to ensure that children and teens (through age 18) of both working and non-working families and pregnant women who meet income guidelines can have the health insurance they need. Families should apply for this program before applying for TEFRA.
Disability Determination Services (DDS) – this unit is part of the Division of Vocational Rehabilitation and completes disability decisions at the request of DPA.
Division of Public Assistance (DPA) – is the State agency that administers the TEFRA Medicaid program and is the central agency in all TEFRA Medicaid eligibility decisions.
Division of Senior and Disability Services (DSDS) – the State agency responsible for making all ICF/MR LOC decisions for children under 3 years of age and completing ICAP assessments for children 3 years of age and older in order to determine ICF/MR LOC.
DPA Case Worker – the central person in any TEFRA application and ongoing Medicaid case. They make the final eligibility decision based on the financial and resource requirements, disability status, and level-of-care (LOC) status.
Inpatient Psychiatric Hospital (IPH) – a LOC category, unique to TEFRA, that may allow families to access Medicaid to cover needed psychiatric services within the community.
Intermediate Care Facility for Mental Retardation (ICF/MR) – a LOC category for children who are diagnosed with one of the five defined qualifying diagnoses (i.e. mental retardation, cerebral palsy, epilepsy, autism or other mental retardation related conditions) according to State administrative codes.
Intermediate Nursing Level-of-Care – to meet this level of care, the documentation submitted must show the need for licensed nursing services ordered by, and under direction, of a physician, and which can only be made available through an institution. This includes observation, assessment and treatment of a long-term illness or disability whose condition is relatively stable and where the emphasis is on maintenance.
Inventory for Client and Agency Planning (ICAP) – this is an objective assessment tool that is used by an independent agency to measure developmental delays according to nationally recognized standards. The assessment is conducted using an interview process.
Level-of-Care (LOC) – the three different categories under which a family may apply for TEFRA Medicaid for a child with significant medical, developmental or psychiatric problems. Not all children who are determined disabled meet a LOC category. Also, high medical costs do not mean a child will meet a LOC or disability definition.
Nursing Facility (NF) – a LOC category for children with a high level of medical needs but who do not experience any developmental delays or mental retardation.
Plan of Care (POC) – a form that is required as part of a TEFRA application that gives the details of the services being provided for the applicant/child.
Skilled Nursing – to meet this level of care, the documentation submitted must show there is need for skilled nursing or structured (active) rehabilitation ordered by and under the direction of a physician. Rehabilitation services must be received five (5) days per week and skilled nursing services must be provided on a 24-hour basis either directly by, or under the supervision of licensed observation, assessment and the treatment of an unstable condition.
Tax Equity Fiscal Responsibility Act (TEFRA) – a specialized Medicaid category for children with disabilities and significant medical needs. Another definition that can be used for TEFRA Medicaid children is “if it was not for parental income and resources the child would be eligible for Supplemental Security Income (SSI)."
