Md. Code Regs. 10.09.62.02

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.62.02 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Affordable Care Act" means the Patient Protection and Affordable Care Act of 2010 (Pub.L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub.L. 111-152), as amended by the Three Percent Withholding Repeal and Job Creation Act (Pub.L. 112-56).

(2) Applicant.

(a) "Applicant" means an individual whose written application for the separate CHIP Program has been submitted to the local health department or the local department of social services but has not received final action.

(b) "Applicant" includes an individual whose application is submitted through a representative.

(3) "Application" means the filing of a written, telephonic, or electronic signed application for health coverage in an insurance affordability program to the Department or its designee.

(4) "Application date" means the date on which a written, telephonic, or electronic signed application is received by the Department or its designee.

(5) "Authorized representative" has the meaning stated in COMAR 10.01.04.12.

(6) "Birthing parent" means the individual who gives birth to the targeted low-income child who is enrolled in the separate CHIP Program on the day prior to their birth.

(7) "CHIP Health Services Initiative" means services offered to improve the health of low-income children pursuant to §2105(a)(1)(D)(ii) of the Social Security Act.

(8) "Department" means the Maryland Department of Health.

(9) "Determination" means a decision regarding an applicant's eligibility for the separate CHIP Program.

(10) "Eligibility worker" means an employee of the local health department, or the local department of social services, responsible for determining the eligibility of applicants and participants.

(11) "Family members" means those individuals living with the applicant whose income is counted as household income under Regulation .07B of this chapter.

(12) "Federal poverty level" means the nonfarm income official poverty level as defined by the Office of Management and Budget and revised annually in accordance with §673(2) of the Omnibus Budget Reconciliation Act of 1981.

(13) "Inpatient services" means services received by a participant while in a medical institution, birthing center, or clinic for which Medical Assistance is provided.

(14) "Institution for mental diseases" means an institution which falls within the jurisdiction of Health-General Article, §19-307(a)(1), Annotated Code of Maryland, and is licensed under COMAR 10.07.04.

(15) "Insurance affordability program" means a program that is one of the following:

(a) Maryland Medicaid;

(b) The Maryland Children's Health Insurance Program (CHIP), including the program known as Maryland Children's Health Program (MCHP) Premium;

(c) The separate CHIP Program;

(d) An optional state basic health program established under §1331 of the Affordable Care Act;

(e) A program that makes available to qualified individuals coverage in a qualified health plan through the Maryland Health Benefit Exchange with advance payments of the premium tax credit established under 26 U.S.C. § 36B of the Internal Revenue Code; or

(f) A program that makes available coverage in a qualified health plan through the Maryland Health Benefit Exchange with cost-sharing reductions established under 42 U.S.C. § 1402 of the Affordable Care Act.

(16) "Living together" means sharing a common household.

(17) "MAGI" means modified adjusted gross income, as calculated for purposes of determining eligibility for insurance affordability programs under the Affordable Care Act.

(18) "Maryland Health Benefit Exchange" means the unit of State government that determines initial and continuing eligibility for the MAGIbased insurance affordability programs, including, by delegation, certain eligibility in the program.

(19) "Maryland Medicaid Managed Care Program" has the meaning stated in COMAR 10.09.24.02.

(20) "Period under consideration" has the meaning stated in COMAR 10.09.24.02.

(21) "Postpartum period" means the period of time beginning on the first day of the month following the end of the pregnancy and ending on the last day of the fourth month after the pregnancy ends.

(22) "Public institution" has the meaning stated in COMAR 10.09.24.02.

(23) "Qualified alien" has the meaning defined in 8 U.S.C. § 1641.

(24) "Participant" means an individual who is certified as eligible for the Maryland Children's Health Program.

(25) "Redetermination" has the meaning stated in COMAR 10.09.24.02.

(26) "Separate CHIP Program" means the program for targeted low-income children established under Title XXI of the Social Security Act.

(27) "Spouse" has the meaning stated in COMAR 10.09.24.02.

(28) "Targeted low-income child" means an individual who qualifies for the Maryland Children's Health Program from conception to birth when the birthing parent is not eligible for Medicaid as a citizen or qualified alien, when the family income is equal to or less than 250 percent of the federal poverty level.

(29) "Title XIX" means the title of the Social Security Act, 42 U.S.C. § 1396 et seq., which governs establishment of a medical assistance program for low-income individuals.

(30) "Title XXI" means the title of the Social Security Act through which funding is provided, in part, for the separate CHIP Program.

Md. Code Regs. 10.09.62.02

Regulations .02 adopted effective 50:22 Md. R. 974, eff. 11/13/2023