Section 16.03.10.076 - MANAGED CARE FOR DUALS: DEFINITIONSFor the purposes of the managed care service delivery system for dual eligible beneficiaries described in Sections 076 through 079 of these rules, the following definitions apply:
01.Dual Eligible. A participant who is eligible for medical assistance under IDAPA 16.03.05, "Eligibility for Aid to the Aged, Blind, and Disabled (AABD)." The participant's Medicaid eligibility must not be based solely on the requirements found under IDAPA 16.03.05, "Eligibility for Aid to the Aged, Blind, and Disabled (AABD)," Section 802. In addition, the participant must be eligible for and enrolled in both Medicare Part A and Medicare Part B.02.Health Plan. A health insurance company responsible for administering Medicaid benefits to dual eligible participants under a provider agreement with the Department.03.Idaho Medicaid Plus. A managed care program designed to administer Medicaid benefits for dual eligible participants administered under a provider agreement between the Department and participating health plans.04.Medicare/Medicaid Coordinated Plan. A managed care program as defined in IDAPA 16.03.17, "Medicare/Medicaid Coordinated Plan Benefits."05.Passive Enrollment. An enrollment process in which a participant is assigned to a participating health plan in a managed care service delivery structure unless the participant actively opts out of the enrollment process.Idaho Admin. Code r. 16.03.10.076