Mont. Admin. r. 37.81.104 - DEFINITIONS
In addition to the definitions in 53-6-1001, MCA, the following definitions apply to this chapter:
(1) "Assets " mean cash or other resources
that a person owns and could convert to cash to be used for his or her support
and maintenance.
(2) "Closed "
means an individual or case that was enrolled but is no longer receiving a
benefit amount or was on a waiting list but is no longer on the waiting list .
(3) "Completed application " means
the applicant has provided all required information to the department .
(4) "Contract " means an agreement
between the department and a PDP provider for the provision of premium payments
for enrollees of the program .
(5)
"Countable income " means the amount of an applicant's income that is compared
to the federal poverty level (FPL) to determine the applicant's FPL percentage.
(6) "Department " means the
Department of Public Health and Human Services.
(7) "Earned income " means salary, wages, and
self-employment net earnings.
(8)
"Eligible " means an applicant has met all the Big Sky Rx Program eligibility
criteria stated in ARM
37.81.307.
(9) "Eligibility threshold " means Big Sky Rx
Program income up to 200% of FPL.
(10) "Enrolled " means an eligible applicant
enrolled in the program .
(11)
"Extra help " means the federal program that assists with premiums, copayments,
and deductibles for clients who meet the social security program 's
requirements. The program is sometimes referred to as Low Income Subsidy (LIS) .
(12) "Family " means individuals
residing together, related by blood, marriage, or adoption, and dependent on
the household for at least one-half of their support.
(13) "Federal poverty level (FPL) " means the
poverty income guidelines published annually in the Federal Register by the
U.S. Department of Health and Human Services.
(14) "First in first served " means completed
applications will be processed and eligible applicants enrolled based on the
date the complete application is received by the department .
(15) "Income " or "family income " means
salary, wage, self-employment net earnings, royalties, honoraria, social
security benefits, veterans benefits, railroad benefits, pensions, workers
compensation, alimony, net rental income , trust income , dividends, and
interest.
(17) "Ineligible " means the individual or
case does not meet the criteria for enrollment in the program .
(18) "Insurer " means an authorized insurer of
the federal Medicare Part D Prescription Drug Plan (PDP) .
(19) "Low income subsidy (LIS) " means the
federal program that assists with premiums, copayments, and deductibles for
clients who meet the social security program 's requirements. The program is
sometimes referred to as Extra Help .
(20) "Open " means a case or individual that
is pending , currently enrolled , or eligible to receive the benefit amount but
on a waiting list .
(21) "Pending "
means the department is waiting to determine eligibility because the
individual's application was incomplete .
(22) "Premium assistance " or "benefit amount "
means the amount of money the department either pays monthly to an insurer for
the provision of benefits for an enrollee or pays to an enrollee.
(23) "Prepopulated " means a computer
generated document that includes information from the department 's records to
be verified by the applicant.
(24)
"Prescription drug plan (PDP) " means the private insurance plans for federal
prescription drug benefit for people with Medicare. The benefit was created by
the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA),
(
42
USC 1302,
1395w-101
through
1395w-152,
and 1395hh) . It is
implemented at 42 CFR, part 423.
(25) "Processing " means the application is
matched against program criteria.
(26) "Program " means the Big Sky Rx Program
administered by the department .
(27) "Qualified " means the applicant is a
Montana resident with a family income at or below 200% of the FPL.
(28) "Renewal " means the process of
verification to remain eligible for Big Sky Rx benefits.
(29) "Representative " means a person who the
applicant has given permission to assist the applicant with program
requirements by communicating with the program and receiving information from
the department .
(30) "Residing "
means living in Montana voluntarily with the intention of making a home here
and not for a temporary purpose.
(31) "Temporary enrollment " means the three
month enrollment allowed for those applicants that are only missing Social
Security Extra Help determination.
(32) "Unearned income " means any income other
than salary, wages, and earnings from self-employment.
(33) "Waiting list " means the list compiled
by the department of applicants who are eligible for premium assistance but who
are not enrolled in the Big Sky Rx Program because funds are not available to
pay their program benefits.
Notes
AUTH: 53-2-201, 53-6-1004, MCA; IMP: 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.