US Healthcare & Home Care Glossary — 25 Key Regulatory & Billing Terms
Complete terminology guide to US healthcare staffing, home care, EVV mandates, OIG exclusions, and FLSA overtime rules.
21st Century Cures Act
A landmark federal healthcare law passed in 2016 designed to accelerate medical innovation, prevent health data blocking, and mandate Electronic Visit Verification for Medicaid home care.
Blended Regular Rate (Overtime)
The weighted average hourly rate used to calculate FLSA overtime when a caregiver works at two or more different pay rates in the same workweek.
CMS Conditions of Participation (CoPs)
Federal health and safety requirements that home health agencies and healthcare organizations must meet to begin and continue participating in Medicare and Medicaid programs.
California Daily Overtime
A California state labor law requiring overtime pay of 1.5x regular pay for hours worked beyond 8 in a single day, and double pay for hours past 12.
Certified Nursing Assistant (CNA)
A credentialed healthcare worker who provides essential daily care (bathing, dressing, mobility, vitals) to patients under the supervision of an RN or LPN.
Closed Model EVV
A state EVV model where the state mandates the use of a single state-contracted vendor for all Medicaid EVV visit capture.
Community Health Accreditation Partner (CHAP)
An independent, non-profit accrediting body with CMS deeming authority for home health, hospice, and home care organizations.
E-Verify & Form I-9
The federal employment eligibility verification process used by employers to verify the identity and employment authorization of newly hired caregivers.
EDI 837P (Professional Healthcare Claim)
The standard electronic data interchange transaction format used by home care and healthcare providers to submit medical claims to insurance payers and Medicaid.
Electronic Visit Verification (EVV)
Electronic Visit Verification (EVV) is a federally mandated computer-based system that electronically documents the time, date, location, service type, caregiver, and client for home care visits.
FLSA Home Care Rule
A federal Fair Labor Standards Act regulation that extended federal minimum wage and overtime protections to direct care workers employed by third-party home care agencies.
HHAeXchange
A widely used home care software platform and state Medicaid EVV aggregator utilized in states such as New York, Texas, Florida, and New Jersey.
Home Health Aide (HHA)
A trained healthcare worker who assists patients recovering from illness, surgery, or disability with personal care and basic health-related tasks in home settings.
Managed Service Provider (MSP)
An outsourced agency or organization that manages a healthcare facility's entire contingent workforce program, coordinating multiple secondary staffing vendors.
Nursys e-Notify
A national electronic nurse licensure database that provides real-time verification and automated alerts regarding discipline or status changes for nurses.
OASIS (Outcome and Assessment Information Set)
A standardized assessment tool used by Medicare-certified home health agencies to collect patient outcome data at admission, discharge, and transfer.
OIG LEIE (List of Excluded Individuals/Entities)
A federal database maintained by the Department of Health and Human Services listing individuals and entities prohibited from participating in Medicare, Medicaid, and federal health programs.
Open Model EVV
A state EVV procurement model that permits home care providers to choose any compliant third-party EVV software as long as data is transmitted to the state aggregator.
Patient-Driven Groupings Model (PDGM)
The Medicare home health payment model that calculates 30-day period reimbursements based on patient clinical characteristics rather than therapy visit volume.
Per Diem Healthcare Staffing
A flexible staffing arrangement where clinicians (nurses, CNAs) are booked for individual single-day or urgent shift assignments on an as-needed basis.
Prior Authorization (Home Care)
Formal approval granted by a Medicaid managed care plan or insurer certifying that a requested home care service is medically necessary and approved for reimbursement.
Sandata Technologies
A major national Electronic Visit Verification (EVV) technology vendor contracted by numerous state Medicaid programs as their state-sponsored EVV aggregator.
Split Shift Premium
An additional mandatory payment owed to hourly workers whose workday schedule is interrupted by non-paid, non-working intervals other than bona fide meal periods.
Travel Nurse Staffing
Contract-based clinical placements where registered nurses relocate for temporary assignments (typically 8 to 13 weeks) at hospitals experiencing acute staffing shortages.
Vendor Management System (VMS)
A cloud software application used by hospitals and health systems to procure, manage, and bill contingent clinical staffing agencies through a single portal.