Utah Admin. Code R382-10-2 - Definitions
(1) The definitions found in Subsections
2110(b) and (c) of the Compilation of Social Security Laws, and in Section
R382-1-2 apply to this rule.
(2) In
addition, the department adopts the following definitions:
(a) "American Indian or Alaska Native" means
someone having origins in any of the original peoples of North and South
America, including Central America, and who maintains tribal affiliation or
community attachment.
(b) "Best
estimate" means the eligibility agency's determination of a household's income
for the upcoming eligibility period, based on past and current circumstances
and anticipated future changes.
(c)
"COBRA" means health insurance coverage under the Consolidated Omnibus Budget
Reconciliation Act of 1985.
(d)
"Copayment and coinsurance" means a portion of the cost for a medical service,
in which the member is responsible to pay for services received under
CHIP.
(e) "Due process month" means
the month that allows time for the member to return verifications, and for the
eligibility agency to determine eligibility and notify the member.
(f) "Eligibility agency" means the Department
of Workforce Services (DWS) that determines eligibility for CHIP under contract
with the department.
(g)
"Employer-sponsored health plan" means a health insurance plan offered by an
employer.
(h) "Ex parte review"
means a review process the agency conducts without contacting the member for
information as defined in 42
CFR 457.343.
(i) "Federally Facilitated Marketplace" (FFM)
means the entity an individual can access to enroll in health insurance and
apply for assistance from insurance affordability programs such as Advanced
Premium Tax Credits, Medicaid, and CHIP.
(j) "Member" means any person who is enrolled
in the Medicaid program and is eligible to receive Medicaid services.
(k) "Modified Adjusted Gross Income" (MAGI)
means the income determined using the methodology defined in
42 CFR
435.603(e).
(l) "Presumptive eligibility" means a period
that a child may receive CHIP benefits based on preliminary information that
the child meets the eligibility criteria.
(m) "Review month" means the last month of
the eligibility certification period for a member, in which the eligibility
agency determines a member's eligibility for a new certification
period.
(n) "Utah's Premium
Partnership for Health Insurance" or "UPP" means the program described in Rule
R414-320.
Notes
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