IDD and Human Services Software Glossary
The disability services sector has its own language. Understanding the terminology used in IDD billing, Medicaid waiver programs, compliance reporting, and case management is essential for agency administrators, billing coordinators, HR managers, and anyone else involved in the operational side of an IDD organization.
This glossary covers the most important terms you will encounter in IDD software, Medicaid billing, and human services administration. Use it as a reference when evaluating software, reviewing compliance requirements, or onboarding new staff.
A
ANCOR (American Network of Community Options and Resources)
The national trade association representing private providers of services to people with disabilities. ANCOR advocates for disability services providers at the federal level and publishes research and policy resources relevant to IDD agencies. Visit ANCOR.
Authorization (Prior Authorization)
Approval from a Medicaid payer or managed care organization that must be obtained before delivering and billing for certain services. Authorizations specify the type of service, the number of units approved, and the period during which the service may be delivered. Billing for services without a valid authorization, or beyond the authorized units, will typically result in a claim denial.
AHCCCS (Arizona Health Care Cost Containment System)
Arizona’s Medicaid program, which administers health care coverage and IDD waiver services for eligible Arizona residents.
B
Billing as a Service
An arrangement in which an IDD software vendor or third-party provider handles the end-to-end billing process on behalf of an agency, including claim preparation, submission, denial management, and reconciliation. Vertex offers Billing as a Service for agencies that need more comprehensive billing support than software alone provides.
Billing Manager
A software module or platform designed to handle the claim preparation, submission, and tracking functions of IDD agency billing. A purpose-built IDD billing manager includes features specific to Medicaid waiver billing, including authorization tracking, EVV integration, and state-specific claim formats.
C
CARF (Commission on Accreditation of Rehabilitation Facilities)
An independent, nonprofit accreditor of health and human services providers, including IDD agencies, rehabilitation facilities, sheltered workshops, and other disability services organizations. CARF accreditation signals to funders, referral sources, and the individuals you serve that your organization meets rigorous international standards for quality, transparency, and accountability in service delivery.
Case Management Software
Software designed to support the documentation, goal tracking, and service coordination functions performed by case managers at IDD agencies. Includes tools for maintaining person-centered plans, tracking client progress, managing authorizations, and generating compliance-related reports.
CDDO (Community Developmental Disability Organization)
In Kansas, CDDOs are the local entities responsible for determining eligibility for IDD services, developing individual service plans, and coordinating service delivery. IDD service providers in Kansas typically work in coordination with their regional CDDO.
CIH Waiver (Community Integration and Habilitation Waiver)
Indiana’s primary Medicaid waiver for adults with intellectual and developmental disabilities, covering a range of community-based supports and services.
Claim Denial
A determination by a payer that a submitted claim does not meet the requirements for reimbursement. Common causes of claim denials in IDD billing include authorization mismatches, documentation deficiencies, EVV data errors, and billing code errors. Denied claims require investigation, correction, and resubmission, which consumes significant staff time.
Commensurate Wage
A wage paid to workers with disabilities under Section 14(c) of the Fair Labor Standards Act that is proportional to the worker’s productivity relative to a worker without a disability performing the same work. Calculating commensurate wages requires productivity measurement data and specific calculation methodology. Vertex Client Payroll Manager handles commensurate wage calculations for agencies operating vocational programs.
Community Living Waiver
One of Pennsylvania’s four ODP-administered Medicaid waivers, designed for individuals with intellectual disabilities who require a high level of support to live in the community.
Consolidated Waiver
Pennsylvania’s largest ODP-administered waiver, providing the broadest range of services for individuals with intellectual disabilities.
D
DDSD (Division of Developmental Disabilities Services)
Oklahoma’s state agency responsible for administering IDD services and Medicaid waiver programs for Oklahomans with developmental disabilities.
DDRS (Division of Disability and Rehabilitative Services)
Indiana’s state agency within FSSA responsible for administering IDD services and related programs.
DDD (Division of Developmental Disabilities)
Arizona’s division within ADES responsible for administering IDD services and funding for eligible Arizonans.
DHS (Department of Human Services)
The state agency responsible for administering Medicaid and human services programs in several states, including Minnesota and Pennsylvania.
Direct Support Professional (DSP)
A frontline worker who provides direct care and support to individuals with intellectual and developmental disabilities. DSPs are the primary workforce of IDD agencies and are typically responsible for capturing EVV data at the point of service delivery.
DODD (Ohio Department of Developmental Disabilities)
Ohio’s state agency responsible for overseeing IDD services and administering Medicaid waiver programs for Ohioans with developmental disabilities.
E
Electronic Visit Verification (EVV)
A technology-based system required by the 21st Century Cures Act that verifies home and community-based service visits by capturing the type of service, the individual receiving service, the date, the location, the provider of service, and the start and end times. EVV data must be transmitted electronically to a state-designated aggregator. Learn more in Vertex’s EVV Compliance Hub.
ERP (Enterprise Resource Planning)
An integrated software system that manages core business processes including finance, accounting, operations, and human resources within a single platform. Vertex offers an IDD-specific ERP built on Microsoft Dynamics 365 Business Central.
EVV Aggregator
The state-designated entity responsible for receiving, storing, and validating EVV data submitted by providers. Some states use a single state-managed aggregator; others allow open vendor models where agencies can use any EVV system that meets technical specifications for data transmission to the aggregator.
F
Fee Schedule
A published list of maximum allowable rates for Medicaid-funded services. States update fee schedules periodically, and IDD agencies must ensure their billing systems reflect current rates to avoid billing errors.
FMAP (Federal Medical Assistance Percentage)
The percentage of Medicaid costs that the federal government reimburses to states. States that fail to meet EVV mandate requirements face reductions in their FMAP as a financial penalty.
ForwardHealth
Wisconsin’s Medicaid program, administered by the Wisconsin Department of Health Services, which processes claims and manages eligibility for Medicaid-funded services including IDD waiver programs.
FSSA (Family and Social Services Administration)
Indiana’s state agency responsible for administering Medicaid, behavioral health, and disability services programs, including IDD waiver programs.
H
HCBS (Home and Community-Based Services)
Medicaid-funded services delivered in home or community settings rather than institutional settings. Most IDD waiver services are categorized as HCBS. The federal HCBS Settings Rule establishes standards for the settings in which HCBS may be delivered.
HCBS Settings Rule
A federal regulation that requires HCBS-funded services to be delivered in settings that are integrated in the broader community, offer individuals choice and control, and meet specific standards for physical and operational characteristics. Compliance with the HCBS Settings Rule affects which service settings are eligible for Medicaid reimbursement.
I
IDD (Intellectual and Developmental Disabilities)
A broad category of conditions characterized by significant limitations in intellectual functioning and adaptive behavior that originate before age 18. IDD includes conditions such as intellectual disability, Down syndrome, autism spectrum disorder, cerebral palsy, and others. IDD agencies provide support services to individuals with these conditions.
Individual Plan of Service (IPOS)
A person-centered plan developed collaboratively with the individual receiving services that documents their goals, the services and supports that will help achieve those goals, and the providers responsible for delivering each service. The IPOS is a foundational compliance document for most Medicaid waiver programs.
IRIS (Include, Respect, I Self-Direct)
Wisconsin’s self-directed Medicaid waiver program for individuals with long-term care needs, including those with IDD, that allows participants to manage their own services and budgets.
K
KanCare
Kansas’s Medicaid managed care program, which processes claims for IDD waiver services through three managed care organizations: Sunflower Health Plan, Aetna Better Health, and United Healthcare Community Plan.
KDADS (Kansas Department for Aging and Disability Services)
The Kansas state agency responsible for administering IDD services and Medicaid waiver programs for Kansans with developmental disabilities.
L
LME-MCO (Local Management Entity/Managed Care Organization)
In North Carolina, LME-MCOs are regional managed care organizations responsible for managing Medicaid-funded behavioral health and IDD services. North Carolina’s Tailored Plan transition has shifted some IDD services from LME-MCO management to a new set of Tailored Plan MCOs.
M
Medicaid Management Information System (MMIS)
The computerized system states use to process Medicaid claims, manage provider enrollment, and maintain beneficiary eligibility information. Each state has its own MMIS or uses a state-branded portal built on a commercial MMIS platform.
Microsoft Business Central
Microsoft’s enterprise resource planning platform, built on Dynamics 365. Vertex offers an IDD-specific implementation of Business Central configured for the financial management needs of IDD agencies and rehabilitation organizations.
MITS (Medicaid Information Technology System)
Ohio’s Medicaid Management Information System, used for claim submission and provider management.
MN-ITS (Minnesota Information Technology Services)
Minnesota’s Medicaid provider portal, used for electronic claim submission and prior authorization management.
O
ODP (Office of Developmental Programs)
Pennsylvania’s state office within the Department of Human Services responsible for administering IDD services, Medicaid waiver programs, and provider oversight.
OKDHS (Oklahoma Department of Human Services)
Oklahoma’s state agency responsible for administering Medicaid and human services programs, including IDD waiver programs through the Division of Developmental Disabilities Services.
P
Person-Centered Planning
A planning approach that places the individual receiving services at the center of the planning process, ensuring that their goals, preferences, and choices drive the development of their support plan. Person-centered planning is a requirement for most Medicaid waiver programs and is fundamental to IDD service delivery.
PIHP (Prepaid Inpatient Health Plan)
In Michigan, PIHPs are regional managed care entities that receive capitated Medicaid funding and are responsible for managing behavioral health and IDD services within their geographic region. PIHPs contract with CMHSPs to deliver services.
PROMISe
Pennsylvania’s Medicaid provider portal, used for electronic claim submission and provider management for AHCCCS services including IDD waiver billing.
R
Referral Portal
A software tool that allows referral sources to submit new client referrals electronically to an IDD agency. Vertex’s Referral Portal streamlines the intake process by enabling partner organizations to submit referrals directly into the Vertex platform.
Rehabilitation Facility
An organization that provides services designed to help individuals with disabilities develop, maintain, or restore functional skills. Many rehabilitation facilities serve individuals with IDD alongside other populations and use IDD-specific software to manage the administrative complexity of their programs.
S
Section 14(c)
A provision of the Fair Labor Standards Act that allows certain employers to pay workers with disabilities wages below the federal minimum wage based on their productivity relative to workers without disabilities. Organizations operating 14(c) programs must obtain certificates from the Department of Labor and follow specific requirements for productivity measurement and wage calculation. See how Vertex supports 14(c) employers and agencies.
Service Authorization
See Authorization.
Sheltered Workshop
An employment setting where individuals with disabilities work in a structured environment, often performing contract production work. Sheltered workshops typically operate 14(c) programs and require specialized software to manage production tracking, commensurate wage calculations, and client payroll. Vertex serves sheltered workshops with purpose-built tools for these functions.
SoonerCare
Oklahoma’s Medicaid program, administered by the Oklahoma Health Care Authority, which processes claims for IDD waiver services.
T
Tailored Plan
North Carolina’s managed care program for individuals with significant behavioral health needs, IDD, and traumatic brain injury, launched in December 2022. Tailored Plans replaced LME-MCO management for many IDD services in North Carolina.
Time and Attendance Software
Software that captures and manages employee work hours, scheduling, and attendance data. For IDD agencies, time and attendance software must integrate with payroll and billing systems to ensure that documented staff hours accurately support service billing. Vertex WorkforceHub Advanced provides IDD-specific time and attendance management.
21st Century Cures Act
Federal legislation enacted in 2016 that, among other provisions, established the EVV mandate for Medicaid-funded personal care and home health services. The Act requires states to implement EVV or face reductions in federal Medicaid funding.
U
Units of Service
The measurement used in Medicaid billing to quantify the amount of a service delivered and billed. Units may be defined in 15-minute increments, hourly, daily, or by other measures depending on the service type and state billing requirements. Accurate unit tracking is essential for billing accuracy and authorization management.
V
Vocational Rehabilitation
Services designed to help individuals with disabilities prepare for, obtain, and maintain employment. IDD agencies that operate vocational programs provide job training, supported employment, and work-based learning experiences, often funded through a combination of Medicaid waivers and state vocational rehabilitation funding.
W
Waiver (Medicaid Waiver)
A Medicaid program authorized under Section 1915(c) of the Social Security Act that allows states to waive certain federal Medicaid requirements in order to provide home and community-based services to individuals who would otherwise require institutional care. Most IDD agency services are funded through state-administered waivers. Common waiver types include HCBS waivers, self-directed waivers, and managed care waivers.
WorkforceHub
Vertex’s time and attendance and workforce management platform. WorkforceHub Advanced provides IDD agencies with scheduling, time tracking, and attendance management tools that integrate directly with payroll and billing.