Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 515.000 - Masshealth: General Policies › Section 515.001 - Definition of Terms

Current through Register 1525, July 5, 2024
The terms listed in 130 CMR 515.001 have the following meanings
				for purposes of MassHealth, as described in
				130 CMR 515.000 through
				522.000:
MassHealth: Other Division Programs
.
Activities of Daily Living (ADLs)
-
				self-care activities including, but not limited to, bathing, grooming,
				dressing, eating, and toileting.
Affidavit
- a written or printed
				statement of fact sworn to or affirmed before a person having legal authority
				to administer such an oath.
American Indian
or
Alaska
				Native
- a person who
(1)
			 is a member of a federally recognized tribe, band, or group as defined in Title
			 25 of U.S.C.;
(2) is an Eskimo,
			 Aleut, or other Alaska Native enrolled by the Secretary of the Interior
			 pursuant to the Alaska Native Claims Settlement Act at
			 43 U.S.C.
			 1601
et seq
.; or
(3) has been determined eligible to receive
			 health-care services from Indian Health Care Providers as an Indian pursuant to
			 42 CFR §
									136.12 or Title V of the Indian Health Care
			 Improvement Act.
Annuity
- a legal instrument that
				makes payments for a designated period of time or for life, regardless if the
				payments are principal, interest, or both.
Appeal
- a written request, by an
				aggrieved applicant or member, for a fair hearing.
Appeal Representative
- a person
				who
(1) is sufficiently aware of the
			 appellant's circumstances to assume responsibility for the accuracy of the
			 statements made during the appeal process, and who has provided the Office of
			 Medicaid Board of Hearings with written authorization from the appellant to act
			 on the appellant's behalf during the appeal process;
(2) has, under applicable law, authority to
			 act on behalf of an appellant in making decisions related to health care or
			 payment for health care. An appeal representative may include, but is not
			 limited to, a guardian, conservator, executor, administrator, holder of power
			 of attorney, or health-care proxy;
(3) is a licensed attorney who notifies the
			 MassHealth Board of Hearings that he or she represents the appellant in an
			 appeal. This shall also include a non-lawyer supervised by a licensed attorney;
			 or
(4) is an authorized
			 representative meeting the requirements of
			 130 CMR
			 501.001:
Appeal
			 Representative
(1), (2), or (3).
Applicant
- a person who completes and
				submits an application for MassHealth, and is awaiting the decision of
				eligibility.
Application
-
see
Senior Application
.
Asset Limit
- the maximum dollar value
				of assets that can be owned by, or available to, the applicant, member, or the
				spouse, which if exceeded, results in ineligibility.
Assets
- property including, but not
				limited to, real estate, personal property, and funds. This term has the same
				meaning as
resources
as defined in
				42
				U.S.C. 1396p(e)(5).
Authorized Representative
.
(1) a person or organization designated as
			 the authorized representative of an applicant or member in a completed, signed
			 Authorized Representative Designation Form or similar designation document
			 submitted to the MassHealth agency in which the authorized representative
			 agrees to comply with rules regarding confidentiality in the course of
			 representing the applicant or member, provided that such person or organization
			 must satisfy one of the following criteria:
(a) an authorized representative may be a
			 person or organization appointed by the applicant or member to act responsibly
			 on his or her behalf in connection with the eligibility process and other
			 ongoing communications with the MassHealth agency. Such person or organization
			 shall have the authority to complete and sign an application on the applicant's
			 behalf, select a health plan, complete and sign a renewal form, receive copies
			 of the applicant or member's notices and other communications from the
			 MassHealth agency which may include protected health-care information, personal
			 data, and financial information and unless otherwise specified, act on behalf
			 of the applicant or member in all other matters with the MassHealth agency or
			 the Health Connector;
(b) an
			 authorized representative may be a person acting responsibly on behalf of the
			 applicant or member who is sufficiently aware of such applicant's or member's
			 circumstances to assume responsibility for the accuracy of the statements made
			 on his or her behalf during the eligibility process and in other communications
			 with the MassHealth agency. Such person shall have the authority to complete
			 and sign an application on the applicant's behalf, select a health plan,
			 complete and sign a renewal form, receive copies of the applicant or member's
			 notices and other communications from the MassHealth agency which may include
			 protected health-care information, personal data, and financial information;
			 or
(c) an authorized representative
			 may be a person acting responsibly on behalf of the applicant or member who
			 has, under applicable law, authority to act on behalf of such applicant or
			 member in making decisions related to health care or payment for health care
			 including, but not limited to, a guardian, conservator, executor,
			 administrator, holder of power of attorney, or health-care proxy. The extent of
			 such person's authority to act on behalf of the applicant or member is
			 determined by the applicable law or underlying legal document;
			 and